Medical devices and methods of placement

ABSTRACT

The present invention provides improved medical devices equipped with a visualization device for intubation, extubation, ventilation, drug delivery, feeding and continuous remote monitoring of a patient. The present invention also provides methods for rapid and accurate placement of a medical device in a patient and continuous real time monitoring, including a remote monitoring, of the patient after the placement.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in part of U.S. patent applicationSer. No. 14/455,470 filed Aug. 8, 2014, the entire disclosure of whichis incorporated herein.

FIELD OF THE INVENTION

The invention provides various medical devices, each with a cameraplaced in a camera tube, which allows for one camera to providecontinuous visualization for each device during and after placement in apatient. A sound device, such as a microphone, is incorporated in manydevices and provides continuous monitoring of breath and heart sounds ina patient. The camera and microphone do not contact the patient'stissues and thus, do not require sterilization. The continuousvisualization and sound monitoring of the patient are in real time andenable remote monitoring as well. Methods for rapid and accurateplacement of a medical device in a patient are provided as well.

BACKGROUND

Various devices are available to stabilize a patient and facilitate hisbreathing, feeding and medication delivery. Such devices are used inpatients during surgical procedures, after certain traumas includingspinal cord injuries, and in patients suffering from certain medicalconditions including advanced Alzheimer disease. These devices includeendotracheal tubes, airway devices, feeding tubes, oral airways, nasalcannulas and the like.

Because human anatomy varies significantly from a patient to a patient,properly placing a medical device in a patient's trachea requires asignificant skill and is a task laced with inherent risk. The taskbecomes even more complicated because the insertion procedure may haveto be performed immediately at an accident site, on pediatric patients,in a nursing home, on a battlefield or at a natural disaster site wheremany patients have to be attended at the same time.

The process of placing a breathing tube in a patient is calledintubation. Devices such as laryngoscopes, videolaryngoscopes,fiberoptic scopes, as well as other proprietary videoscopes have beendeveloped. These devices provide accuracy for initial placement, but donot provide continuous visualization or mobility of the image after amedical device has been placed in a patient. Newer devices, such asVivasight SL or DL endotracheal tubes, provide continuous visualization,but are costly because they depend on a single use of disposable camerasand they are not transferrable from one medical device to another. TheTotaltrack VLM supraglottic airway has a proprietary reusable camera foronly its one device, and it cannot be transferred to other medicaldevices.

Thus, there remains the need for improved devices which can be easilymonitored remotely by a qualified personal during placement and afterplacement for an adverse reaction. After a medical device has beenplaced in a patient, the need remains to monitor in real time thepatient's possible adverse reactions such as for example, aspiration,airway secretion, apnea, etc.

SUMMARY OF THE INVENTION

At least some of these needs are addressed by present medical deviceswhich are equipped with a portable universal visualization device inwhich a camera is contained within a separate camera tube and whichtransmits information that can be accessed and monitored remotely andsimultaneously from several patients in real time.

One embodiment provides a medical visualization device which comprises acamera tube with a distal end and a proximal end. The distal end issealed with a transparent material and a proximal end has an opening. Acamera with a wire is placed inside of the camera tube. The camera canbe placed inside of the camera tube and it can be retracted from thecamera tube on demand. The camera can be reused in various deviceswithout sterilization. The camera can transmit images to a remotelocation wirelessly. In some embodiments, the camera tube comprises afiber optic material. The visualization device can be equipped with atleast one of the following: a light source, a stylet, a bougie and asound- and temperature-monitoring device which can transmit theinformation to a remote location wirelessly. The visualization devicecan transmit images, sounds and other data to any number of remotelylocated monitoring devices and/or data storage devices. Such devicesinclude, but are not limited to, a wireless portable device, smartphone, tablet, watch, cell phone, hand-held wireless device, computer,remote data server, radio, television, walkie-talkie and the like.

A further embodiment provides a method of continuous monitoring of apatient's at least one internal organ, the method comprising placing inthe patient the visualization device with the camera in the sealedcamera tube, causing the camera to transmit images of the internal organin real time through the transparent material at the distal end of thecamera tube, and analyzing the transmitted images. In some embodiments,the images are transmitted wirelessly to at least one remote location.

Various internal organs can be monitored by this method, includingnasopharynx, pharynx, hypopharynx, supraglottic structures, airway,trachea, vocal cords, stomach, and vagina.

In some embodiments, the length of the camera tube in the visualizationdevice is adjustable and it can be adjusted to the length of at leastone of the following devices: an endotracheal tube, a supraglotticairway, airway device, oral airway, dilator, tracheostomy device,intubating oral airway, esophageal stethoscope, nasal cannula, feedingtube, suction tube and endotracheal changing tube.

Further embodiments provide a method for placing a medical device in apatient in which the medical device is equipped with the visualizationdevice and a bougie. The medical device is inserted in the patient andthe placement of the device is guided with the bougie under continuousvisualization.

A kit for monitoring a patient's internal organ in real time is alsoprovided. The kit comprises a camera tube with the adjustable length andwith at least one ring attached externally to the camera tube, whereinthe camera tube has a distal end and a proximal end and wherein thedistal end of the camera tube is sealed with a transparent material; anda reusable camera which can be placed and removed from the camera tubeand which can transmit images wirelessly to at least one remotelocation. This real time information obtained with the visualizationdevice can be transferred or stored to multiple distant monitoringsites.

Also provided is a medical device comprising a visualization devicesealed to, attached to or otherwise combined with at least one of thefollowing second devices: an endotracheal tube, a supraglottic airwaydevice, a ventilator adaptive cap, a dilator, a tracheostomy device, anasal trumpet, a an oral airway, an esophageal stethoscope, alaryngoscope, a speculum, a nasal cannula, a feeding tube, a suctiontube, a suction catheter, and an endotracheal changing tube; and whereinthe visualization device comprises a camera tube with a distal end andproximal end, the distal end being sealed with a transparent materialand a camera being placed inside of the camera tube through an openingat the proximal end. These medical devices can be further equipped withat least one of the following a bougie, a flexible stylet and a sound-and temperature-monitoring device. In some embodiments, thevisualization device is sealed, attached or otherwise connectedexternally to the second device. In other embodiments, the visualizationdevice can be placed inside of the second device. Various endotrachealtubes equipped with the visualization device are contemplated as well,including an endotracheal tube which comprises a sleeve through whichthe visualization device can be inserted, an endotracheal tube intowhich the visualization device is placed internally through a ventilatoradaptive cap and an endotracheal tube to which the visualization deviceis attached externally.

Further embodiments provide an oral airway device comprising a tubalbody with a central lumen and a visualization device attached to thetubal body, wherein the diameter of the lumen is such that anendotracheal tube can be placed insider the lumen and wherein thevisualization device comprises a camera tube sealed at the distal endwith a transparent material and a camera placed inside the tube throughthe opening at the proximal end, end wherein the camera tube ispositioned along the tubal body. The visualization device can beattached to the tubal body either internally or externally. The oralairway device can further comprise a removable handle which can beconnected to the oral airway device with a holder.

Further embodiments provide an oral airway device with a rotatingcentral passageway made of two half-cylinders, a first externalhalf-cylinder and second internal half-cylinder, wherein the secondhalf-cylinder fits inside the first half-cylinder and can glide insidethe first half-cylinder along the proximal-distal axis of the firsthalf-cylinder and wherein the second half-cylinder can also rotateinside the first half-cylinder and thereby create a completely enclosedcentral passageway or only partially enclosed central passageway with alateral opening, and wherein the first half-cylinder and the secondhalf-cylinder can be completely separated from each other.

Other embodiments provide a supraglottic ventilating tube with camera,comprising a ventilating tube with the distal end and the proximal endand equipped with a visualization device comprising a camera tubeattached externally along the ventilating tube, and a camera which canbe placed inside the camera tube, wherein an inflatable cuff which wrapsaround the ventilating tube and the camera tube being positioned underthe cuff.

Methods for intubating and extubating a patient are also provided inwhich an endotracheal tube or ventilating tube is loaded onto the secondhalf-cylinder of the oral airway device which is then assembled with thefirst half-cylinder of the oral airway device and the assembly isinserted into a patient under continuous visualization and monitoring.

Another embodiment provides a tubeless intubating device, comprising anellipsoid body attached to a handle and a visualization device attachedto the intubating device, wherein the visualization device comprises acamera tube and a camera which can be placed and removed from the cameratube and wherein the ellipsoid body comprises a lumen and canal whichopens beneath the handle.

Other embodiments provide a sliding endotracheal cuff device, comprisinga tube with the distal end and the proximal end, a rail attachedexternally on the tube along the proximal-distal axis, wherein the railhas a groove which opens inside the tube, wherein the device furthercomprises a cuff which wraps around the tube externally at the distalportion of the tube, and wherein the device further comprises a cameratube attached externally to the tube along the proximal-distal axis, anda camera which can be positioned inside and removed from the cameratube.

Further embodiments include an assembly in which an oral airway deviceis inserted inside of a carrier which comprises a tubal body with alumen and a first balloon which caps the distal end of the carrier. Thecarrier has a lumen opening proximal to the first balloon and thecarrier has a second balloon circumventing the tubal body of the carrierproximally to the lumen. The carrier may further optionally comprise athird balloon circumventing the body of the carrier proximally to thesecond balloon. The balloons can be inflated with an inflating means.Methods of intubating and extubating a patient with the carrier assemblyare provided as well.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A, 1B and 1C depict a side view of an embodiment for avisualization device as shown in FIG. 1A which can be further equippedwith a stylet as shown in FIGS. 1B and 1C.

FIG. 2 depicts a side view of an embodiment for an endotracheal deviceequipped with a visualization device.

FIG. 3 depicts a side view of an alternative embodiment for anendotracheal device equipped with a visualization device.

FIGS. 4A and 4B depict two embodiments showing a visualization deviceattached to a built-in ventilator adaptive cap. FIG. 4A is an embodimentwithout a light source and FIG. 4B is an embodiment with a light source.

FIGS. 5A, 5B and 5C depict side views of further embodiments of avisualization device attached to a built-in ventilator adaptive cap anddelivered through a sliding sleeve (FIGS. 5A and 5B), with furtherembodiment in FIG. 5C which includes a bougie or a flexible stylet asshown in the insert.

FIGS. 6A and 6B depict side views of an embodiment for an endotrachealdevice equipped with a visualization device delivered through a slidingsleeve.

FIGS. 7A and 7B depict side views of an alternative embodiment for anendotracheal device equipped with a visualization device and deliveredthrough a sliding sleeve.

FIG. 8 is a side view of an embodiment for an endotracheal deviceequipped with a bougie.

FIGS. 9A, 9B and 9C are a side view of a visualization device equippedwith rings. FIG. 9A is a side view of a visualization device equippedwith two rings. FIG. 9B is a side view of the visualization device asshown in FIG. 9A, but equipped further with a bougie. FIG. 9C is a sideview of the visualization device as shown in FIG. 9A, but equippedfurther with a light source. FIG. 9D is a cross-sectional view throughthe visualization device of FIG. 9A showing a ring connected to thecamera tube. FIG. 9E is a cross-sectional view through the visualizationdevice of FIG. 9A showing an adjustable sliding ring with a claspconnected to the camera tube. FIG. 9F is a side view of an endotrachealtube to which the visualization device of FIG. 9A is connected with twosliding rings.

FIG. 10 is a side view of a supraglottic airway device equipped with avisualization device. An endotracheal device of FIG. 3 is shown as aninsert on the left and a flexible guided stylet is shown as an insert onthe right.

FIGS. 11A and 11B depict a side view of an alternative airway devicewith a visualization device. FIG. 11A is a side view of the airwaydevice and FIG. 11B is the device as shown in FIG. 11A, but with aventilator adaptive cap.

FIGS. 12A, 12B and 12C depict an oral airway intubating device with avisualization device. FIG. 12A is a side view of the oral airway device,while FIGS. 12B and 12C are cross-sections through the airway device inits full cylinder form (FIG. 12B) and in its half-cylinder form in whichone half-cylinder is retracted into the other half-cylinder (FIG. 12C).

FIG. 13 depicts a side view of a dilator with a visualization device.

FIGS. 14A and 14B depict a side view of a tracheostomy device with avisualization device. FIG. 14A depicts an embodiment in which thevisualization device is attached externally to a tracheostomy tube,while FIG. 14B depicts an embodiment in which the visualization deviceis attached inside of the tracheostomy tube.

FIG. 15 depicts a side view of a nasal trumpet with a visualizationdevice.

FIGS. 16A-16C depict a side view of an oral airway equipped with avisualization device and FIG. 16D depicts an intubating oral airway alsoequipped with a visualization device. FIG. 16A shows a visualizationdevice being positioned inside of the oral airway. FIG. 16B is the sameas FIG. 16A, but includes a light source for the visualization device.FIG. 16C is the same as FIG. 16A, but includes a whistle. FIG. 16D is anintubating oral airway device with a main lumen into which anendotracheal tube can be placed. FIG. 16E is an intubating/extubatingoral airway device with a main lumen as shown in FIG. 16D and into whichan endotracheal tube has been placed.

FIGS. 16F and 16G are embodiments showing a portion of anintubating/extubating oral airway device with a detachable handle whichcan be attached to a holder on an intubating/extubating oral airwaydevice.

FIGS. 16H, and 16J-16P depict an intubating/extubating oral airwaydevice with a rotating central passageway. FIGS. 16H and 16J depict thecapacity of intubating/extubating oral airway device with a rotatingcentral passageway to extend distally. The embodiment of FIGS. 16H and16J has a camera tube with camera placed externally on theintubating/extubating oral airway, while the embodiment of FIG. 16Kprovides the intubating/extubating oral airway in which the camera tubeis placed inside of the rotating central passageway. FIGS. 16L-16Ndemonstrate further how the inner half-cylinder can rotate in theintubating/extubating oral airway to create a fully enclosed centralpassageway. FIGS. 16O-16P depict insertion of an endotracheal tubeinside the rotating central passageway of the intubating/extubating oralairway.

FIGS. 17A and 17B depict a side view for a supraglottic airway deviceequipped with a visualization device and working tube and bougie tube.

FIGS. 18A-18B depict a side view for a one-piece laryngoscope with avisualization device. FIG. 18A shows a laryngoscope with a visualizationdevice, and FIG. 18B is the same, except it is further equipped with abougie and the visualization device is equipped with a light source.

FIG. 19 depicts a side view of a speculum with a visualization device.

FIGS. 20A-F depict a nasal cannula with a visualization device. FIG. 20Adepict positioning of the cannula on a patient's head and FIG. 20B isthe same as in FIG. 20A, except the visualization device is equippedwith a light source. FIG. 20C is a side view of the cannula of FIG. 20A,and FIG. 20D is a side view of the cannula of FIG. 20B. FIG. 20E is across-sectional view of a patient's head with the cannula of FIG. 20Ainserted. FIG. 20F is a further embodiment in which a nasal cannula witha visualization device as shown in FIG. 20A is further combined with anexternal stethoscope.

FIG. 21 is a feeding tube equipped with a visualization device.

FIG. 22A, 22B, 22C depict various embodiments of a suction tube equippedwith a visualization device. FIG. 22A depicts a visualization devicepositioned inside of the suction tube. FIG. 22B the same as in 22A, butequipped further with a bougie, and FIG. 22C is the same as FIG. 22B,but showing the bougie protruding from the distal end of the suctiontube.

FIG. 23 depicts a suction catheter equipped with a visualization device.

FIG. 24 depicts an endotracheal changing tube equipped with avisualization device.

FIGS. 25A-25D depict a supraglottic ventilating tube with camera. FIG.25A is a side view of the supraglottic ventilating tube with camera.FIG. 25B is an enlarged view of the supraglottic ventilating tube distaltip with a cuff. FIGS. 25C and 25D depict insertion of the supraglotticventilating tube into an intubating/extubating oral airway.

FIGS. 26A-26J depict a tubeless intubating device. FIG. 26A depicts theupper surface of the tubeless intubating device. FIG. 26B depicts thebottom surface of the tubeless intubating device. FIGS. 26C-26F depictloading the tubeless intubating device with an endotracheal tube forinsertion into a patient. FIG. 26G depicts the upper surface of thetubeless intubating device without a cuff, while FIG. 26H depicts thebottom surface of the tubeless intubating device of FIG. 26G. FIGS. 26Iand 26J depict loading of the device FIG. 26G with a supraglotticairway.

FIGS. 27A-27G depict a sliding endotracheal cuff (FIGS. 27A, 27C-27G)and loading an endotracheal tube into the sliding cuff (FIG. 27B).

FIGS. 28A-28B depict an endotracheal tube with a visualization devicewhich can slide along the endotracheal tube and be removed from theendotracheal tube.

FIGS. 29A-29C depict a sliding camera tube with rail and placing of thecamera tube into a laryngoscope.

FIGS. 30A-30B depict a supraglottic airway device with built inendoscope guide (FIG. 30A) and insertion of the device into a patient(FIG. 30B).

FIGS. 31A and 31B depict an assembly of a naso-gastric tube with avisualization device.

FIG. 32 depicts an oral airway embodiment.

FIGS. 33A-33C depict further embodiments of an endotracheal tube with anexternally attached camera tube. FIG. 33A depicts an embodiment with asuction tube, FIG. 33B with a medication dispensing device and FIG. 33Cwith biopsy forceps.

FIGS. 34A-34H depict various embodiments for an oral airway device. FIG.34A depicts an embodiment with a separate lumen for an esophagealblocker. An endotracheal tube which can be placed into the oral airwaydevice is also shown. FIG. 34B is the same embodiment as in 34A, butwith a ventilator cap instead of an endotracheal tube. FIG. 34C is anoral airway device without a balloon with an endotracheal tube alsoshown. FIG. 34D is the same embodiment as in 34C, but with a ventilatorcap instead of an endotracheal tube. FIGS. 34E-34H depict an expendableoral airway device with a carrier. FIG. 34E shows placement of an oralairway device into a carrier. FIG. 34F is an enlarged view of thecarrier from FIG. 34E. FIGS. 34G and 34H depict an oral airway devicepositioned inside of the carrier, with FIG. 34G showing the oral airwaydevice positioned fully inside the carrier, while FIG. 34H showing theoral airway device expending from the carrier.

FIGS. 35A-35B are further embodiments of an oral airway device. FIG. 35Adepicts an oral airway device positioned in a patient, while FIG. 35Bprovides an embodiment of an oral airway device with a side opening.

FIGS. 36A, 36B, 36C depict a nasopharyngeal airway device. FIG. 36A isan embodiment with two balloons, while FIG. 36B is an embodiment withthree balloons. FIG. 36C shows positioning of the three balloonnasopharyngeal airway device in a patient.

DETAILED DESCRIPTION

The present invention provides improved medical devices equipped with avisualization device for intubation, ventilation, feeding and monitoringof a patient. The present invention also provides methods for rapid andaccurate placement of a medical device in a patient and remotecontinuous real-time monitoring of the patient after the placement.

These medical devices are equipped with a visualization device in whicha camera is placed in a separate sealed camera tube. As the camera doesnot come in contact with a patient, there is no need to sterilize thecamera and the same camera can be reused in many applications. Thus, thesame camera can be switched between different medical devices whichmonitor internal organs such as medical devices that are placed inpatient's airway, larynx, gastrointestinal tract, chest or vaginalcavity. In some embodiments, the camera is disposable.

One embodiment provides a visualization device as shown in FIG. 1A andits further embodiments as shown in FIGS. 1B and 1C. A visualizationdevice, generally 10, in FIG. 1A comprises a camera tube 12 with adistal end 14 and a proximal end 16. The camera tube 12 can be a plastictubing. In some embodiments, the camera tube 12 may comprise afiber-optic material. The camera tube 12 is sealed at the distal end 14with a transparent material 17. The diameter of camera tube 12 isdesigned in such a way that a camera 18 with wire 20 can be insertedinside of the camera tube 12 through an opening at the proximal end 16and moved down the camera tube 12 toward the distal end 14, so that thecamera 18 transmits continuously images obtained through the transparentmaterial 17. The length of the camera tube 12 can vary and it can beadjusted dependent on the length of a medical device with which thevisualization device is to be used. For example, the length of thecamera tube 12 may be longer when the visualization device 10 is usedwith a feeding tube in comparison to the length of the camera tube 12when the visualization device 10 is used with an endotracheal tube. Insome embodiments, the visualization device obtains images and transmitswirelessly, broadcasts or records this information to at least onedevice positioned at a remote location.

Because the camera tube 12 is sealed at the distal end 14 with thetransparent material 17, the camera 18 does not come in contact withpatient's tissues or fluids and therefore, the camera 18 does not haveto be sterilized or to be disposable, and it can be reused in furtherapplications. However, the camera 18 can be disposable in someapplications. The camera 18 can be loaded with a chip and equipped toobtain and transmit digital images in real time. The camera 18 isfurther connected by an electric wire 20 to an image receiving andprocessing device (not shown) such as a computer equipped with a monitoror a computer network. The camera 18 may also be in communicationwirelessly with an image-receiving device located at any location,including multiple locations and remote locations. Because the lengthand diameter of the camera tube 12 can be adjusted based on patient'sneeds, the visualization device 10 is suitable for a broad variety ofpatients, including pediatric patients and adult patients with abnormalanatomy or trauma.

As the visualization device 10 is bendable and flexible, thevisualization device 10 is easy to insert in a patient and remove fromthe patient. The camera 18 may have its own light source. As thevisualization device 10 transmits images from a patient in real time, itcan be used for guiding a medical device for proper placement. Thus,some embodiments are concerned with methods for rapid and accurateplacement of a medical device inside of a patient, including a methodfor guided and rapid placement into patient's airway, larynx,gastrointestinal tract, chest or vaginal cavity under continuousvisualization.

As shown in embodiment of FIG. 1B, the visualization device 10 can befurther equipped with a stylet 22 which can be sealed onto or otherwiseattached to the camera tube 12 externally on at least one side of thecamera tube 12 along the proximal-to-distal (16-14) axis of the cameratube 12. The stylet 22 can be made of metal wire or some other sturdymaterial with the purpose to keep the otherwise flexible visualizationdevice 10 in a particular shape. In some embodiments, the stylet 22 canbe of the same length as the camera tube 12. In other embodiments, thestylet 22 is shorter than the camera tube 12 such that at a least aportion of the camera tube 12 on either the proximal end 16 or distalend 14, or on the both ends 16 and 14 is not in contact with the stylet22. As shown in FIG. 1C, the stylet 22 can be bent into various shapesand it retains the shape into which it has been bent, which permits forvisualization device 10, which is otherwise flexible, to retain aparticular shape.

In alternative embodiments, the visualization device 10 can be equippedwith a bougie which can be attached to the camera tube 12 externally onat least one side of the camera lumen 12 along the proximal-distal(16-14) axis of the visualization device 10.

The bougie can be made of various materials, including plastic materialwhich is bendable. As the bougie is bendable, but keeps a shape intowhich it is bent, the bougie is suitable for guiding the visualizationdevice 10 inside of a patient. In some embodiments, the bougie can be ofthe same length as the camera tube 12. In other embodiments, the bougiecan be made shorter or longer than the camera tube 12 such that only aportion of the camera tube 12 is in contact with the bougie. In someembodiments, the bougie protrudes on at least the distal end 14.

The visualization device 10 can be further equipped with a portablelight source (not shown) which can be either built-in the camera 18 orit can be built-in the camera tube 12. In alternative, a light sourcecan remain outside the camera tube 12 on the proximal end 16, but stillbe placed such that the light source sheds light inside of the cameratube 12.

In embodiments of FIGS. 1A-1C, the camera tube 12 can be disposable,while the camera 18 is reusable without the need of sterilization.However, the camera 18 can be also disposable in at least someembodiments.

During placement in a patient, a visualization device 10 either alone orin combination with another medical device is positioned such that it isinserted with its distal end 14 in the patient under continuousvisualization with the camera 18.

Any of the visualization devices 10 described above can be attached,sealed or otherwise connected to a disposable or non-disposable medicaldevice either externally or internally and as described in more detailbelow. Various medical devices for pediatric and adult patients can bebuilt such that the camera device tube 12 is sealed or attached to themedical device during manufacturing. In some embodiments, thevisualization device 10 can slide or glide along the medical device towhich the visualization device 10 is attached. For example, the cameratube 12 of the visualization device 10 can be equipped with a set ofrings, a rail or a half-cylinder which will allow the camera tube 12 toslide or glide along the medical device to which the visualizationdevice 10 is attached.

In other embodiments, the visualization device 10 can be sold as a kitwhich can be attached by a medical practitioner to a pre-made medicaldevice for pediatric and adult patients, based on a particular patient'sindividual needs. The length of the camera tube 12 can vary such thatthe camera tube 12 is of the same or similar length with a medicaldevice to which the visualization device 10 is sealed, attached orotherwise connected to.

Having the ability to verify placement for a medical device in real timefrom near and far allows several experts to assist and verify placement.This is accomplished by equipping the medical device with thevisualization device 10. In some embodiments, a method is provided inwhich the visualization device 10 is used for placing a medical devicein a patient in ambulances, on battlefields, in nursing homes orhospitals. The visualization device 10 provides the ability to monitorin real time a patient. Because the visualization device 10 may interactwith a plethora of devices disposable and otherwise, the use of thedevice 10 on various medical devices provides for a method in which amedical practitioner can customize a proper device for each patient orsituation. Having the same camera equipment that can interact withvarious medical devices provides economy of scale such that even thesmallest of organizations can have all the proper vigilance andtechnology.

At least in some embodiments the visualization device 10 can be used inassembly with at least one medical device as described in more detailbelow. A method in which the visualization device 10 is used on anairway device allows continuous visualization of any of the following ina patient in real time: nasopharynx, pharynx/hypo pharynx, supraglotticstructures, airway, internal organ anatomy, vocal cords during normaland abnormal ventilation. This method also allows detection of abnormalanatomy and abnormal vocal cord movements.

Referring to FIG. 2, this embodiment provides an endotracheal device,generally 30. The endotracheal device 30 comprises an endotracheal tube32 with a distal end 32A and a proximal end 32B. The visualizationdevice 10 is sealed or otherwise attached externally on at least oneside of the endotracheal tube 32, along the proximal-distal (32B-32A)axis of the endotracheal tube 32. The visualization device 10 comprisesessentially of all elements as shown in FIG. 1A, with the camera 18inserted inside of the camera tube 12 through an opening at the proximalend 16 of the camera tube 12, all the way down to the distal end 14 andthe opening of the distal end 14 being sealed with the transparentmaterial 17. Because the camera 18 is positioned inside of the sealedcamera tube 12, the camera 18 does not come into contact with a patientand the camera 18 does not need to be sterilized and can be reused inmultiple applications. Thus, the camera 12 does not have to bedisposable or to be sterilized before further applications. However, thecamera 18 can be disposable in at least some applications.

As the camera 18 is contained inside of the separate camera tube 12which is positioned externally on the endotracheal tube 32, a diameterof the camera tube 12 is not limited by a diameter of the endotrachealtube 32. Thus, the diameter of the camera tube 12 can be larger orsmaller than the diameter of the endotracheal tube 32.

Thus, the visualization device 10 can be used on endotracheal devicesfor pediatric patients and patients with abnormal anatomy. In someembodiments, the visualization device 10 has a diameter larger than thatof the endotracheal tube 32.

The camera 18 is connected by electric wire 20 to an external devicesuch as a computer and monitor (not shown). At least in someembodiments, the visualization device 10 is further equipped with alight source 21. The light source 21 can be kept outside of the cameratube 12, but in proximity with the proximal end 16 of the visualizationtube 12 so that the light source 21 sheds light inside of the cameratube 12. In alternative embodiments, the light source 21 can be built-inthe camera tube 12 or in further embodiments, the light source 21 can bebuilt-in the camera 18.

At least in some applications, the camera 18 is a digital cameraequipped with a chip and it collects and transmits images continuously.The camera 18 can be connected wirelessly or hard-wired with a computernetwork (not shown) which collects and analyzes images obtained by thecamera 18. This arrangement permits for remote, continuous and real timemonitoring of the endotracheal device 30 during placement andafter-placement in a patient. Thus, an accurate and rapid placement ofthe endotracheal device 30 can be achieved. Further and because thevisualization device 10 continues to acquire images after theendotracheal device 30 is placed inside of a patient, the patient can bemonitored in real time for adverse reactions such as bleeding, airwayobstruction, shifting or malfunctioning, etc. of the endotracheal device30 and other reactions. The endotracheal device 30 may continue totransmit images and information for as long as it remains in a patient.

In some embodiments, the endotracheal tube 32 is further fitted with acuff 34 at its distal end 32A. In other embodiments, the endotrachealtube 32 is not fitted with the cuff 34. The cuff 34 can be inflated witha device 36 after the endotracheal device 30 is placed in a patient andits proper positioning inside of the patient is verified by imagesobtained with the visualization device 10.

The endotracheal device 30 can be further equipped with asound-monitoring device 38 which is sealed onto or otherwise attachedexternally on one side of the endotracheal tube 32 along theproximal-distal axis (32B-32A) of the endotracheal tube 32. Thesound-monitoring device 38 can be a microphone placed inside of aplastic tube 40. It monitors heart beats and breathing tones and can beconnected by wire or wirelessly to a remote device which collects andmonitors patient's vital signals. In the embodiment of FIG. 2, thevisualization device 10 is placed proximally to the cuff 34 andexternally to the endotracheal tube 32. It will be understood that theendotracheal device 30 can be built with any endotracheal tube 32,including single-lumen and double-lumen tubes. The endotracheal device30 can be used for either pediatric or adult patients. The endotrachealdevice 30 can be made in various sizes.

In another embodiment and as shown in FIG. 3, an endotracheal device,generally 50, comprises an endotracheal tube 52 with a distal end 52Aand a proximal end 52B, and a visualization device 10 placed inside ofthe endotracheal tube 52 through an opening in the proximal end 52B. Inthis embodiment, the visualization device 10 is attached to a built-inventilator adaptable cap 68 which connects the endotracheal device 50 toa ventilator (not shown) through an outlet 70. The built-in ventilatoradaptable cap 68 comprises an opening 72 through the cap 68. Thevisualization device 10 is passed through the opening 72 and is placedinside of the endotracheal tube 52. The built-in ventilator adaptablecap 68 is then connected with the endotracheal tube 52 at the proximalend 52B of the endotracheal tube 52.

The visualization device 10 is the same as the visualization device 10of FIG. 1A and it comprises a camera tube 12 with a sealed distal end 14and an open proximal end 16. A camera 18 is placed inside of the cameratube 12 through the proximal end 16 of the camera tube 12. The camera 18is connected by electrical wire 20 to an image-monitoring device (notshown). In some embodiments, the camera 18 is connected wireless to animage-monitoring device (not shown). The camera 18 collects imagescontinuously and in real time through a transparent material 17 withwhich the distal end 14 of the camera tube 12 is sealed. The images canbe transmitted to a remote location.

The endotracheal tube 52 can be optionally equipped with a cuff 64 atthe distal end 52A such that the cuff 64 wraps around the endotrachealtube 52 and the cuff 64 can be inflated with a device 65, once theendotracheal device 50 is properly placed inside of a patient's airway.As can be seen from FIG. 3, the distal end 14 of the visualizationdevice 10 extends distally from the distal end 52A of the endotrachealtube 52 and below the cuff 64 such that even when the cuff 64 isinflated with a device 65 after placement in a patient, thevisualization device 10 can still record images inside of a patient'sbody and below the cuff 64. Further, the endotracheal device 50 may havean elliptical opening 67 at the distal end 52A and the visualizationdevice 10 can be positioned inside of the endotracheal tube 52 such thatthe distal end 14 of the visualization device 10 aligns with or is inclose proximity with the elliptical opening 67 of the endotracheal tube52.

Referring to FIGS. 4A and 4B, further embodiments provide avisualization device 10 assembled with a built-in ventilator adaptablecap 68 which connects to a ventilator (not shown) by an outlet 70. Thevisualization device 10 is inserted through an opening 72 in thebuilt-in ventilator adaptable cap 68 as shown in FIGS. 4A and 4B. Asshown in FIG. 4B, the visualization device 10 can be further equippedwith a light source 74 which can be a part of the camera tube 12 or itcan be built in the camera 18, or it can remain outside the built-inventilator adaptable cap 68. The visualization device 10 is assembledwith the built-in ventilator adaptable cap 68 as shown in FIGS. 4A and4B and can be then used in an endotracheal tube as described inconnection with FIG. 3 or in a supraglottic device or with a laryngealmask or with any other medical device to which a built-in ventilatoradaptable cap 68 can be attached. As shown in FIGS. 4A and 4B, thecamera tube 12 has a distal end 14 and a proximal end 16. The camera 18is placed inside of the tube 12 through an opening in the proximal end16 and moved all the way down to the distal end 14 which is sealed witha transparent material 17. The camera 18 collects images through thetransparent material 17 and transmits the images in real time to amonitoring device which can be located remotely.

Further embodiments for a built-in ventilator adaptable cap 68 equippedwith a visualization device 10 are shown in FIGS. 5A, 5B and 5C. As canbe appreciated from FIG. 5A, the visualization device 10 comprises thecamera 18 inside of the camera tube 12. The visualization device 10 isinserted through the ventilator adaptable cap 68. As shown in theembodiment of FIG. 5A, a plastic clear sleeve 76 can be attached overthe adaptable cap 68 such that the sleeve 76 can slide up and down asshown in FIGS. 5A and 5B in the proximal-distal direction, which allowsthe visualization device 10 to remain sterile during insertion andremoval. As the visualization device 10 is inserted and removed throughthe sleeve 76, the visualization device 10 remains sterile and free ofcontamination. The sleeve 76 is long enough to maintain the wholevisualization device 10 outside the ventilation cap and remain sterile.A further embodiment is shown in FIG. 5C in which the visualizationdevice 10 is inserted through the sleeve 76 as shown in FIGS. 5A and 5B,except a bougie 78 is added through a bougie tube 80.

The bougie 78 can be replaced with a flexible guided stylet 82 as shownin the insert to FIG. 5C which rotates and guides a stylet inside of apatient, which is protected from patient's tissues. If the tube 80 isused with a stylet, then the tube 80 has to be sealed at the distal end.Additional tubes can be attached and placed through the sleeve 76. Suchtubes include, but are not limited to a suctions tube and a tool tubewhich can be used for delivering biopsy forceps and other tools. Theassembly of the built-in ventilator adaptable cap 68 and visualizationdevice 10 with the sleeve 76 can be used with any medical device towhich a built-in ventilator adaptable cap can be attached, including anendotracheal tube as described in connection with FIG. 3, a supraglotticdevice or with a laryngeal mask airway. If an embodiment with a bougieor stylet is used as described in connection with FIG. 5C, the bougie 78can protrude distally or slide independently from a medical device andguide the medical device movement inside of a patient during placementunder visualization with the visualization device 10.

Further embodiments for an endotracheal device equipped with avisualization device, generally 84, are shown in FIGS. 6A and 6B. As canbe appreciated from FIG. 6A, the visualization device 10 which comprisesthe camera 18 inside of the camera tube 12 can be inserted inside of anendotracheal tube 86 through an opening 87 on one side of theendotracheal tube 86. As shown in the embodiment of FIG. 6A, a plasticsleeve 92 can be attached over the opening 87 such that the sleeve 92can slide up and down as shown in FIGS. 6A and 6B, which facilitateskeeping the visualization device 10 sterile while it is moved in or outof the endotracheal tube 86. As the visualization device 10 is insertedand removed from the endotracheal tube 86 through the sleeve 92, thevisualization device 10 remains sterile and free of contamination. Thevisualization device 10 can be removed entirely from the endotrachealtube 86 through the sleeve 92 and remain sterile. The endotracheal tube86 may be equipped with a cuff 88 positioned near the distal end 86A.The visualization device 10 can move inside the endotracheal tube 86along the proximal-distal (86B-86A) axis such that the visualizationdevice 10 is distal to the cuff 88 or the visualization device 10 canprotrude outside the endotracheal tube 86 distally as shown in FIG. 6B.This permits for obtaining images from a patient with the visualizationdevice 10 after the cuff 88 is inflated with a device 90 and obtainingthe images from the area in a patient's body which is distal to the cuff88. This distal to the cuff 88 area is available for monitoring afterthe cuff 88 is inflated because of the visualization device 10 in whichthe camera 18 collects images through the transparent material 17 at thedistal end 14.

In this embodiment, the visualization device can slide up and downinside of an endotracheal tube, which permits advancement and retractionof the camera tube 12 while maintaining sterility of an endotrachealtube into which the visualization device 10 can be inserted as describedabove. The camera 18 can be easily advanced inside of the camera tube 12and provide inspection of the endotracheal tube through its length aswell as distal to the tip of the endotracheal tube.

Further embodiments for an endotracheal device, generally 100, equippedwith a visualization device 10 are shown in FIGS. 7A and 7B. Additionaltubes can be attached to the tube 10 or be placed adjacent to the tube10. Such tubes include, but are not limited to a suction tube, a tubefor delivering instruments such as forceps, a bougie or flexible stylet.As can be appreciated from FIG. 7A, the visualization device 10comprises the camera 18 inside of the camera tube 12 positionedexternally on the endotracheal tube 102 and along the proximal-distal(102B-102A) axis. As shown in the embodiment of FIG. 7A, a plasticsleeve 108 can be attached to the endotracheal tube 102 such that thesleeve 108 can slide up and down outside the endotracheal tube 102 asshown in FIGS. 7A and 7B, which facilitates the movement of thevisualization device 10 along the proximal-distal (102B-102A) axis ofthe endotracheal tube 102. As the visualization device 10 is insertedand removed through the sleeve 108, the visualization device 10 remainssterile and free of contamination. The endotracheal tube 102 may beequipped with a cuff 104 wrapped around the endotracheal tube 102 nearits distal end 102A. The visualization device 10 moves outside theendotracheal tube 102 along the proximal-distal axis 102B-102A such thatthe visualization device 10 can be proximal to the cuff 104. This alsopermits for obtaining images from a patient with the visualizationdevice 10 after the cuff 88 is inflated with a device 106. The cameratube 12 can slide proximal or distal of the cuff 104. Thus, at least insome embodiments, the camera tube 12 would be into a sealed tunnel.

FIG. 8 depicts a further embodiment of an endotracheal device, generally110. The device 110 can be equipped with the visualization device 10 andthe sound tube 40 described in connection with FIG. 2 (not shown). Theendotracheal device is further equipped with a bougie 116 which canslide up and down along the proximal-distal (116B-116A) axis inside of atube 118 which is attached externally to the endotracheal tube 111. Theendotracheal tube 111 is equipped with a cuff 112 located in proximityto a distal end 110A of the tube. The cuff 112 can be inflated with adevice 114 after the endotracheal device 110 is placed inside of apatient. The visualization device 10 can be sealed or attached to theendotracheal tube 111 either outside or inside as described above inconnection with embodiments provided by FIGS. 2, 3, 4A, 4B, 5A, 5B, 6A,6B, 7A and 7B. The bougie 116 guides the movement of the endotrachealdevice 111 during placement in a patient under visualization with thevisualization device 10 and permits guided sliding down the medicaldevice over the bougie 116 inside of the patient's airway.

Further embodiments of a visualization device, generally 120, are shownin FIGS. 9A-9C. As shown in FIG. 9A, the camera tube 12 can be equippedwith at least one, and preferably two external rings 122 which aresealed or otherwise connected by means 124 to the camera tube 12. Insome embodiments, one ring 122 is positioned at about ⅓ of the cameratube length from the proximal end 16 and the other ring is positioned atabout ⅔ of the camera tube length from the proximal end. While in theembodiment of FIG. 9A, the camera tube 12 is equipped with two rings122, other embodiments include those in which more than 2 rings are usedor only one ring is used. The positioning of the rings along theproximal-distal (16-14) axis of the camera tube 12 can also vary. Othermodalities include a clasp or a plastic band to hold the camera tube 12.

As in all other embodiments, the camera tube 12 has a distal end 14sealed with a transparent material 17 and a proximal end 16 with anopening through which a camera 18 is inserted into the camera tube 12.As shown in FIG. 9B, the visualization device 120 can be furtherequipped with a tube 118 sealed or otherwise attached externally alongthe proximal-distal (16-14) axis of the camera tube 12. A bougie 116 isplaced inside of the tube 118 such that a distal end 116A of the bougie116 protrudes distally over the camera tube 12, while its proximal end116B extends outside the visualization device 120 proximally and can beused by a medical provider to rotate the distal end 116A and in this wayguide the movement of the visualization device 120 along with a medicaldevice to which it is attached.

As shown in FIG. 9C, the visualization device 120 can be furtherequipped with a light source 21 which can be either built in the cameratube 12, built in the camera 18 or it can be kept outside thevisualization device 120 and outside the patient's body. Thevisualization device 120 is attached to a medical device with the rings122, and this permits for customized positioning of the visualizationdevice 120 as it can slide up and down along a proximal-distal axis of amedical device.

As shown in a cross-sectional view in FIG. 9D, the ring 122 can be ofany diameter in order to fit on a medical device of choice. As shownfurther in FIG. 9E, at least in some embodiments the ring 122 may have aclasp 126 such that the diameter of the ring 122 can be adjustedaccording to a diameter of a medical device to which the visualizationdevice 120 is attached with the rings 122.

An embodiment as shown in FIG. 9F provides an assembly, generally 128,in which the visualization device 120 is attached with the rings 122 toan endotracheal tube 52. The rings 122 can slide up and down along theproximal-distal (52B-52A) axis of the endotracheal tube 52, and in thisway the position of the visualization device 120 can be adjusted withrespect to the endotracheal tube 52. Further, the rings 122 can rotatearound the endotracheal tube 52, which permits altering the positioningof the camera device 120 if images are needed from a different areainside of a patient.

Because the rings 122 can be adjustable, the visualization device 120can be used with an endotracheal tube of any size, including those forpediatric patients. Further, the visualization device 120 with at leasttwo rings connected externally to the camera tube 12 can be provided asa kit, and a medical practitioner can assemble the visualization devicewith any conventional endotracheal tube or any other conventionalmedical device for which visualization and monitoring are needed at thetime of treatment.

Further embodiments provide an intubation method in which anendotracheal tube, including any of the endotracheal tubes describedabove and equipped with the visualization device as described above, isplaced in patient's airway and positioned under the patient's vocalcords under constant visualization by the visualization device 10.

Referring to FIG. 10, it depicts a side view of a supraglottic airwaydevice, generally 130. Any standard endotracheal tube known in the artand an endotracheal device of FIG. 3 is shown in the insert on the leftof FIG. 10 can be used in combination with the supraglottic airwaydevice 130.

The supraglottic airway device 130 comprises a supraglottic tubal body131 with a distal end 131A and a proximal end 131B and a lumen 146. Thesupraglottic airway device 130 includes a designated intubation tube 133which is inserted into the lumen 146 and into which an endotrachealdevice 50 can be placed as shown in FIG. 10. The distal end 133A of theintubation tube 133 ends with an elliptical opening 140 which is locateddistally from a cuff 132 which can be inflated with a device 134. Theintubation tube 133 has a plurality of holes 148 distributed throughoutits body to allow ventilation from outlet 144 through tubal body 131.

While a standard endotracheal device, including an endotracheal device50, may be equipped with a visualization device, the supraglottic airwaydevice 130 comprises its own visualization device 10 which is placed inthe lumen 146. The visualization device 10 comprises a camera tube 12with a distal end 14 and a proximal end 16. The distal end 14 is sealedwith a transparent material 17. The camera tube 12 is sealed orotherwise attached externally to the intubation tube 133 along theproximal-distal (131B-131A) axis. The supraglottic device 130 can befurther equipped with a bougie 116 which is located inside of the tube118. The tube 118 is placed inside of the lumen 146 and such that thedistal end 116A of the bougie 116 protrudes from the tube 118 andoutside the supraglottic tubal body 131 through an elliptical opening142 which is located on the supraglottic tubal body 131 slightlyproximally from the distal end 131A. The elliptic opening 142 of thesupraglottic tubal body 131 overlaps partially with the elliptic opening140 of the intubation tube 133. The bougie tube has its own openingthrough 140.

At the distal end 131A, the tubal body 131 is capped with a balloon 136which can be inflated with a device 138. In some embodiments, the bougie116 can be replaced with a flexible guided stylet 82 shown on the rightof FIG. 10.

In addition to the visualization device 10, the supraglottic device 130can be also equipped with a sound- and temperature-monitoring device 38which is located inside a tube 40 which is sealed or otherwise attachedexternally to the tubal body 131 along the proximal-distal (131B-131A)axis. The sound device 38 can monitor patient's heart beat and breathingafter the supraglottic device 130 is placed inside of the patient. Onits proximal end 131B, the tubal body 131 may be connected to aventilator (not shown) though an outlet 144. Because the supraglotticdevice 130 can ventilate in a closed circuit through the tubal body 131,an endotracheal tube 50 can be placed inside of the intubation tube 133without the need to stop ventilation and therefore, the supraglotticdevice 130 provides continuous ventilation, continuous visualization inreal time through the visualization device 10 and continuous sound andtemperature monitoring by the sound monitoring device 38 with atemperature probe. This real time information can be transferred orstored to multiple distant monitoring sites.

Other advantages for the supraglottic airway device include the abilityto intubate, extubate and to easily reintubate if needed undercontinuous ventilation and the ability to continuously visualize vocalcords and supraglottic structures. The device 130 is suitable forapplications in children and adults. Further, the device 130 is equippedwith the cuff 132 for blocking the pharynx and the balloon 136 whichblocks the esophagus after the device 130 is placed in a patient.Furthermore, an endotracheal tube can be placed just proximal to thevocal cords in the tubal body 133. This permits ventilation through 144and tubal body 131 uninterrupted.

Referring to FIGS. 11A and 11B, an alternative embodiment for an airwaydevice, generally 150, is provided. This device can be used in pediatricand adult patients as it is adoptable to different sizes. It providescontinuous visualization of supraglottic structures and it can beadvanced, retracted, or rotated, side to side to provide directvisualization of vocal cords. As can be appreciated from FIGS. 11A and11B, the airway device 150 comprises a tubal body 152 with a distal end152A and a proximal end 152B and a lumen 153. The tubal body 152 may beconnected to a ventilator through an outlet 154. A visualization device10 is sealed or otherwise attached inside of the tubal body 152 alongthe proximal-distal (152B-152A) axis on at least one side. Thevisualization device 10 comprises a camera tube 12 with a distal end 14and a proximal end 16. The camera tube 12 is sealed at the distal end 14with a transparent material 17. The proximal end 16 of the camera tube12 remains open and a camera 18 is inserted in the camera tube 12through the proximal end 16. The camera 18 does not come in contact witha patient's body and it does not have to be sterilized, it does not haveto be disposable, although it may be disposable in at least someapplications. The visualization device 10 can be further equipped with alight source which can be built in the camera tube 12 or be a part ofthe camera 18. In alternative, a light source may be left outside thecamera tube 12, but still shed enough light inside of the camera tube 12for the camera 18 to obtain images inside of a patient's body.

An intubation tube 156 is placed inside of the lumen 153 of the tubalbody 152 along the proximal-distal (152B-152A) axis. The intubation tube156 shares a lumen 119 with a bougie 116 which is inserted inside thelumen 119 along the proximal-distal (152B-152A) axis such that a distalend 116A of the bougie 116 may protrude outside the tubal body 152 atthe distal end 152A and proximal end 1168 may protrude outside the tubalbody 152 and the proximal end 152B can be used by a medical practitionerto guide the movement of the airway device 150 with the bougie 116during placement in a patient, including advancing the bougie 116through patient's vocal cords under direct visualization by camera 18.The intubation tube 156 has a plurality of holes 157 distributed alongthe intubation tube 156.

At least in some embodiments, the airway device 150 is further equippedwith a sound- and temperature-monitoring device 38 which can be insertedin a tube 40 which is sealed or otherwise attached inside of the tubalbody 152 along the proximal-distal (152B-152A) axis such as the distalend of the sound-monitoring device 38 is positioned at or near thedistal end 152A of the tubal body 152, which is also equipped with acuff 158 along the perimeter of the tubal body 152 at the distal end152A. The intubation tube 156 is designed such that at least in someembodiments the intubation tube 156 has a ramp 160 at the distal end152A of the airway device 150. A standard endotracheal tube, includingthose described in various embodiments above, can be placed inside ofthe lumen 119 in the intubation tube 156 for positioning in a patient.

As shown in FIG. 11B, a ventilator adaptable cap 68 and a lid 69 areattached to the tubal body 152 at the proximal end 152B. Theendotracheal tube is inserted into the device 150 through the cap 68.Using the cap 68 with the lid 69 on the airway device 150 is preferredwhen ventilation is accomplished through an outlet 154.

Yet another embodiment for an oral airway device, generally 170, isprovided as shown in FIGS. 12 A, 12B and 12C. As can be appreciated fromFIG. 12A, the airway device 170 comprises a tubal body 172 with a distalend 172A and a proximal end 172B. The tubal body 172 ends with two ramps174 and 176 at the distal end 172B. As can be appreciated from a sideview in FIG. 12A and cross-sectional views of the tubal body 172 inFIGS. 12B and 12C, the tubal body 172 is made of two half-cylinders 178and 180. The half-cylinder 178 is slightly smaller in diameter than thehalf-cylinder 180. The tubal body 172 can be present in one of the twoforms: as a full cylinder shown in FIG. 12B or as a half-cylinder asshown in FIG. 12C. The half-cylinder 178 and the half-cylinder 180 areconnected by means such that the half-cylinder 178 can rotate andretract into the half-cylinder 180. The half-cylinder form of FIG. 12Cis achieved by the half-cylinder 178 rotating at about 180 degrees andaligning with the half-cylinder 180 such that the half-cylinder 178 islocated inside of the half-cylinder 180 as shown in FIG. 12C.

A visualization device, generally 10, is sealed or otherwise attachedexternally to the half-cylinder 180 along the proximal-distal(172B-172A) axis. The visualization device 10 comprises of a camera tube12 with a distal end 14 and a proximal end 16. The distal end 14 issealed with a transparent material 17. A camera 18 is placed through anopening at the proximal end 16 into the camera tube 12 and is movedinside the camera tube 12 to the distal end 14. Similarly to all otherembodiments, the camera 18 does not come in contact with a patient'sbody, and it does not have to be disposable, does not have to besterilized and it can be reused in multiple devices. The camera 18 isconnected with wire 20 to at least one monitoring device and ittransmits images in real time. The camera 18 can be connected wirelesslyto at least one monitoring device which can be positioned at some remotelocation. A light source can be added as described in connection withthe visualization device in other applications.

The half-cylinder 180 ends in two ramps 174 and 176 at the distal end172A. The ramp 174 is smaller in size than the ramp 176 and the tworamps are superimposed over each other such as the smaller ramp 174 isproximal to a lumen 182 created by half-cylinders 178 and 180 when theyare in the full-cylinder form as shown in FIG. 12B, while the ramp 176is distal to the lumen 182. The ramps 174 and 176 are flexible andabsorb the shock from sliding and releasing an endotracheal tube whichcan be delivered into a patient by the oral airway device 170. The rampsalso facilitate the removal of the oral airway device 170 after theendotracheal tube is placed inside of the patient.

As shown in FIG. 12A, the oral airway intubating device 170 can befurther equipped with a bougie 160 which can be inserted into a tube 118along the proximal-distal (172B-172A) axis such that a distal end 116Aof the bougie 116 protrudes distally from the oral airway device 170 anda proximal end 116B protrudes outside the oral airway device proximatelyand can be used to manipulate the distal end 116A of the bougie 116 suchthat it guides the movement of the airway device 170 during placement ina patient. The bougie tube 118 is located on the smaller half-cylinder178 and it shares the lumen 182 with the tubal body 172.

A further embodiment provides a dilator with a visualization device,generally 190 in FIG. 13. As can be appreciated from FIG. 13, thedilator 190 comprises a tubal body 192 with a proximal end 192B and adistal end 192A. A certain distal portion of the tubal body 192 istapered into a conical shape 192C such that the opening at the distalend 192A of the tubal body 192 is significantly smaller in diameter incomparison to an opening at the proximal end 192B. A visualizationdevice 10 is positioned inside of a lumen 195 of the tubal body 192 andalong the proximal-distal (192B-192A) axis. The visualization device 10may be sealed or otherwise attached inside of the tubal body 192. Thevisualization device 10 is essentially the same device as shown in FIG.1A, and it comprises a camera tube 12 with a proximal end 16 and adistal end 14. The distal end 14 of the camera tube 12 is in closeproximity with the distal end 192A of the tubal body 192. A camera 18which can be either disposable or reusable is placed inside of thecamera tube 12 through an opening at the proximal end 16 and all the waydown to the distal end 14 of the camera tube 12, which is sealed with atransparent material 17. Just like other embodiments, the visualizationdevice 10 can be equipped with a light source located outside of thedilator 194 or built in the camera tube 12. In some embodiments, thelight source can be built in the camera 18.

As shown in FIG. 13, the camera 18 is connected by electrical wire 20 toa monitoring device (not shown). In some embodiments, the camera 18 canbe in communication with a monitoring device wirelessly. A guide wire atthe proximal end 194A is positioned inside of the lumen 195 of the tubalbody 192. A proximate end 1948 of the guide wire 194 protrudes outsideof the tubal body 192 at the proximal end 1928. The visualization device10 verifies appropriate placement of the dilator device 190 and allowsmobility of continuous visualization as dilation proceeds. The dilatordevice 190 is especially well suited for use with the Seldingertechnique.

Further embodiments provide various tracheostomy tubes equipped with avisualization device. FIG. 14A depicts a side view of an embodiment fora tracheostomy device, generally 200. The device 200 comprises a tubalbody 202 with a distal end 202A and a proximal end 202B. An inflatablecuff 204 is wrapped around the tubal body 200 in some proximity to thedistal end 202A, but never at the very distal end 202A. The cuff 204 canbe inflated with a device 206 after proper placement of the device 200in a patient. At the proximal end 202B, the tubal body 202 protrudesthrough a plastic plate 208 such that some portion of the tubal body 202is proximal to the plastic plate and will remain outside of a patient'sneck after the device 202 is positioned in the patient. The plasticplate 208 may be oval in shape with the tubal body 202 protruding fromthe plate in the middle of the oval plastic plate 208. The plastic plate208 may have two openings 209, one on each side of the plate such thatthe device 200 can be secured around patient's neck with some bandage bytying the device 200 through the openings 209 around patient's neck.

In the embodiment of FIG. 14A, the visualization device 10 is sealed orotherwise attached to the tubal body 202 externally. The visualizationdevice 10 comprises a camera tube 12 which is sealed or otherwiseattached externally along the proximal-distal (202B-202A) axis to thetubal body 202. The camera tube 12 is placed under the cuff 204 suchthat the cuff 204 wraps over the camera tube 12 and a distal end 14 ofthe camera tube 12 is distal to the cuff 204. The distal end 14 issealed with a transparent material 17. A proximal end 16 of the cameratube 12 protrudes through the plastic plate 208 and remains outside ofpatient's neck. A camera 18 can be placed inside of the camera tube 12through an opening in the proximal end 16. The camera 18 is notdisposable, does not need to be sterilized and can be easily removedfrom the camera tube 12. The camera 18 is connected by electrical wire20 to a monitoring device. In further embodiments, the camera 18 can bein communication with a monitoring device wirelessly. A light source canbe added to the visualization device 10 as was described in otherembodiments above.

FIG. 14B depicts another embodiment for a tracheosomy device, generally210. In this embodiment, the device 210 comprises of the same tubal body202, cuff 204, plate 208 and other components as was discussed inconnection with the device 200. However, unlike the device 200, avisualization device 10 is placed inside of a lumen 203 of the tubalbody 202. The visualization device 10 comprises a camera tube 12 with adistal end 14 and a proximal end 16. The camera tube 12 may be sealed orotherwise attached internally to the tubal body 202 along theproximal-distal (202B-202A) axis such as the distal end 14 of the cameratube 12 is in close proximity with the distal end 202A of the tubal body202. The distal end 14 is sealed with a transparent material 17. Acamera 18 is placed inside of the camera tube 12 through an opening atthe proximal end 16 which remains outside of the patient's neck afterthe device 210 is placed in the patient. The camera 18 is connected byelectrical wire 20 to a monitoring device. In other embodiments, thecamera 18 communicates with a monitoring device wirelessly. In someembodiments, the visualization device 10 comprises a light source.

A further embodiment provides a nasal trumpet with a visualizationdevice, generally 220 in FIG. 15. The trumpet 220 comprises a tubal body222 with a proximal end 222B and a distal end 222A. Two fasteners 224are attached at the proximal end 222B of the tubal body 222. Afterplacing the trumpet 220 in a patient, the proximal portion of the tubalbody 222 with the fasteners 224 remains outside of the patient, and thefasteners 224 can be used to secure the trumpet 220 around the patient'shead.

A visualization device 10 is sealed or otherwise attached to the tubalbody 222 externally along the proximal-distal (222B-222A) axis. Thevisualization device 10 comprises a camera tube 12 with a proximal end16 and a distal end 14. The distal end is in near proximity with thedistal end 222A of the tubal body 222. The distal end 14 is sealed witha transparent material 17. A camera 18 is placed inside of the cameratube 12 through an opening at the proximal end 16. The camera 18 ismoved all the way to the distal end 14 and collects images in real timeinside of a patient's body during placement of the device 220 as well asafter the device 220 has been properly placed and secured. As in otherembodiments, the camera 18 does not come in contact with patient's body,does not have to be sterilized and can be reused in multiple devices orin different patients. The camera 18 communicates with a monitoringdevice (not shown) either with electrical wire 20 or wirelessly, orboth.

Further embodiments provide various oral airways as shown in FIGS. 16A,16B, 16C, and 16D. Referring to FIG. 16A, an oral airway with avisualization device, generally 230, comprises a tubal body 232 with alumen 233. The tubal body is slightly curved in a hook-like shape alongthe proximal-distal (232B-232A) axis. A visualization device 10 isplaced inside of the lumen 233 of the tubal body 232. The visualizationdevice 10 comprises a camera tube 12 and a camera 18. The camera tube 12may be sealed or otherwise attached internally to the tubal body 232inside of the lumen 233 and along the proximal-distal (232B-232A) axis.The camera tube 12 has a proximal end 16 and a distal end 14. The distalend 14 is in close proximity with the distal end 232A of the tubal body232. The distal end 14 is sealed with a transparent material 17.

The camera tube 12 has an opening at the proximal end 16 through whichthe camera 18 is inserted into the camera tube 12 all the way to thedistal end 14. The camera 18 communicates with a monitoring deviceeither wirelessly or by electrical wire 20. The embodiment shown in FIG.16B is the same as in FIG. 16A, except a light source 21 is added to thevisualization device 10. The light source 21 may remain outside of thecamera tube 12 or it may be built in the camera tube 12 or it may be apart of the camera 18.

The embodiment shown in FIG. 16C is the same as that of the FIG. 16A,except two whistles 234A and 234B are added inside of the lumen 233 ofthe tubal body 232. The whistle 234B is located at the proximal end ofthe tubal body 232 and it produces a sound when a patient breathes in.The whistle 234A is located at the distal end of the tubal body 232 andit produces a sound when the patient breathes out.

Further embodiments include an oral airway as shown in FIGS. 16A-16C,but further equipped with a sound and temperature monitoring devicewhich is also placed inside of the lumen 233 and transmits informationto a monitoring device which can be positioned at a remote location.

The embodiment of FIG. 16D is an intubating airway device with avisualization device, generally 230. The intubating airway device 230comprises a tubal body 232 with a lumen 233 in which an endotrachealtube can be placed. A visualization device 10 comprises a camera tube 12with a distal end 14 and a proximal end 16. The distal end 14 is sealedwith a transparent material 17. A camera 18 is placed inside of thecamera tube 12 through an opening at the proximal end 16. The cameratube 12 is placed inside the lumen 233 of the tubal body 232.

A bougie 116 is added inside of the tubal body 232 such that the bougie116 is inserted in a tube 118 which shares the lumen with the lumen 233along the proximal-distal (232B-232A) axis. A portion 116A of the bougie116 protrudes outside the distal end 232A of the tubal body 232. Aportion 1168 of the bougie 116 protrudes outside the tubal body 232 fromthe proximal end 232B and over vocal cords. An endotracheal tube can bepositioned inside the lumen 233 and the bougie 116 is used underconstant visualization from the camera 10 to guide the placement of theendotracheal tube through patient's vocal cords. The distal end 14 ofthe camera tube 12 is in proximity with the distal portion 116A of thebougie 116 and therefore, the guided placement takes place underconstant visualization.

FIG. 16E is the same intubating airway device with a visualizationdevice, 230 of FIG. 16D, but with an endotracheal tube 234 insertedinside of the lumen 233 of the tubal body 232 of the intubating airwaydevice 230. As can be appreciated from FIG. 16E, any endotracheal devicecan be easily inserted and removed by sliding through the lumen 233.Thus, the intubating airway device 230 can be used to intubate, extubateand reintubate under continuous visualization. The device providescontinued visualization during intubation and extubation as well asduring ventilation via the camera 18 in the camera tube 12. Thus, thedevice 230 can be used for intubating and extubating without lifting thepatient's mandible, tongue or soft tissues of the oral airways and thismethod is one of the embodiments.

FIGS. 16F and 16G provide a further embodiment for an oral airwayintubating/extubating device. As can be seen from the figures, a handle236 can be connected to the proximal end 232B of the oral airwayintubating/extubating device 230. The handle 236 can be made of anysuitable sturdy material such as for example, plastic, wood or metal.The handle 236 can be of any shape and size that would provide asufficient grip for a hand of a medical provider. In some embodiments,the handle 236 is a cylinder. In other embodiments, it can be made inany other shape suitable for gripping by a hand. On one end, the handle236 has a means 237 for attaching to a holder 238 which is connected theproximal surface 232C of the oral airway intubating/extubating device230, as shown in FIG. 16G. The means 237 can be made in any shapesuitable for connection to the holder 238. In some embodiments, themeans 237 can be in a shape of a cylinder as shown in FIG. 16F. In someembodiments, the holder 238 can be in a shape of a half-cylinderslightly bigger in diameter than the means 237 as shown in FIG. 16F suchas that the means 237 fits tightly inside the holder 238.

When the handle 236 is connected to the holder 238, a medical serviceprovider can use the handle 236 to lift the patient's mandible andtongue. Thus, intubation/extubation can be easily accomplished on anypatient, including patients who are unconscious and by any medicalservice provider, including those who are of small physical statute.Because the handle 236 can be disconnected from the holder 238, thehandle 236 can be removed after it is no longer in use. It can bereconnected with the holder 238 later if needed for furthermanipulations of the patient's lower jaw and/or tongue.

FIGS. 16H, and 16J-16P provide a further embodiment for an oral airwayintubating/extubating device with a rotating central passageway,generally 350. The oral airway intubating/extubating device with arotating central passageway comprises of two half-cylinders, an innerhalf-cylinder 351 and outer half-cylinder 352. The half-cylinder 351 issmaller in diameter and fits inside the larger half-cylinder 352 such asthe inner half-cylinder 351 can slide proximally and distally inside theouter half-cylinder 352, as shown in FIG. 16J. At least in someapplications, the inner half-cylinder 351 can be removed completely fromthe device 350, such as only the outer half-cylinder 352 remainsinserted in a patient, as shown in FIG. 16H.

As can be appreciated from FIG. 16J, the inner half-cylinder 351 may belonger than the outer half-cylinder 352 and the inner half-cylinder 351can slide distally and proximally inside the outer half-cylinder 352. Ascan be appreciated from FIGS. 16H and 16J, a camera tube 12 can beattached externally along the outer half-cylinder 352 in someembodiments and a camera 18 can be placed inside the camera tube 12 andprovide continuous visualization during intubation and extubation.

In other embodiments, the camera tube 12 can be positioned inside theinner half-cylinder 351, as shown in FIG. 16K such that the camera 18provides continuous visualization during intubation and extubation.

As can be appreciated from FIGS. 16L-16N, the inner half-cylinder 351can rotate inside the outer half-cylinder 352 such that the twohalf-cylinders may create a completely enclosed passageway as shown inFIG. 16N or the half-cylinders may create a passageway which is notfully enclosed and remains open on at least one side as shown in FIG.16L. In some embodiments, the inner half-cylinder 351 may have at leastone retractable extension 353 which when extended outside thehalf-cylinder 351 locks the half-cylinder 351 in a position on thehalf-cylinder 352 and prevents the half-cylinder 351 from slidingfurther distally along the outer half-cylinder 352.

FIGS. 16O and 16P depict two different ways of inserting an endotrachealtube 354 inside the oral airway intubating/extubating device with arotating central passageway 350. As shown in FIG. 16O, the endotrachealtube 354 can be conveniently placed inside the rotating centralpassageway of the oral airway intubating/extubating device 350. Inalternative and as shown in FIG. 16P, the endotracheal tube 354 can befirst placed inside the inner half-cylinder 351 which is then insertedinsider the outer cylinder 352. This assembly permits flexibility andmakes insertion of endotracheal tubes of various sizes, including smallpediatric endotracheal tubes, very accurate and under constantvisualization of a camera. Further and because the inner half-cylinder351 can slide along the proximal-distal axis, the intubation can beaccurate and customized for a particular patient to fit the patient'ssize and anatomy. Alternatively, the device 250 may be placed over theendotracheal tube 354 which is already in place in a patient in order toprovide constant visualization and a conduit for extubation and possiblereintubation.

Further embodiments provide a supraglottic airway device with avisualization device. Referring to FIG. 17A, it depicts a supraglotticairway device with a visualization device, generally 240. It comprises abody 242 with a lumen 243 into which a sound-monitoring device 246 isplaced. The body 242 may have a cylinder-like shape tapered at thedistal end, and with the distal end the body 242 protruding with atongue-like tip 248. At least a portion of the body 242 surface isslightly curved toward the lumen 243 and creates a surface 249. Thevisualization device, generally 10, comprises a camera tube 12 with adistal end 14 which is sealed with a transparent material 17, and acamera 18 which is placed inside of the camera tube 12 through anopening at the proximal end of the camera tube 12. The camera tube ispositioned externally on surface 249 along the distal-proximal axis ofthe body 242. The camera tube 12 is connected with the surface 249 by asliding means 245 such that the camera tube 12 can slide along the242A-242B axis on the surface 249.

The camera 18 is placed inside of the camera tube 12 and because thecamera tube 12 is sealed at the distal end 14, the camera 18 does notcome in contact with a patient and the camera 18 does not need to besterilized and it can be reused in other applications. The camera 18 isconnected by electric wire 20 or wirelessly to a monitoring device. Thecamera 18 is not disposable and can be reused in other applications.

The device 240 is further equipped with a bougie tube 244 which is alsolocated on the surface 249 and is connected to the surface 249 with asliding means 245 such that the bougie tube 244 can slide along the242A-242B axis. FIG. 17B provides an alternative embodiment for thedevice 240, in which the sound and temperature monitoring device 246 canprotrude through an opening at the 248 tip.

A further embodiment provides a one-piece video-laryngoscope with avisualization device, generally 250, as shown in FIGS. 18A and 18B. Thevideo-laryngoscope 250 comprises a tubal body 252 which has a proximalend 252B and a distal end 252A. The tubal body 252 extends with ascoop-like portion 254 at the distal end 252A. The scoop-like portion254 curves horizontally such that the distal end 254A of the scoop-likeportion 254 is nearly parallel to the proximal end 254B of thescoop-like portion. The tubal body 252 has an opening 256 near itsdistal end 252A. A visualization device 10 which comprises a camera 18placed inside of a camera tube 12 is placed through the opening 256 suchthat the distal end 14 of the camera tube 12 may be in proximity withthe proximal end 254A of the scoop-like portion 254. The device can beeasily inserted to an upper esophagus and visualize vocal cords.

However, the position of the distal end 14 can be adjusted as needed bysliding the camera tube 12 through the opening 256. The distal end 14 issealed with a transparent material 17 such that the camera 18 does notcome in contact with a patient's body and therefore, the camera 18 doesnot need to be sterilized and it can be reused in multiple applications.The camera 18 is inserted into the camera tube 12 through an opening atthe proximal end 16. The camera 18 is connected to at least onemonitoring device either by electrical wire 20 or wirelessly.

The embodiment of FIG. 18B is the same as that of FIG. 18A, except alight source 21 is added to the visualization device 10 as described inconnection with the light source 21 in other medical devices above. Abougie 116 in a tube 118 is also added through the opening 256, and thedistal end 116A of the bougie 116 can be manipulated at the proximal end116B such that the placement of the device 250 is guided undercontinuous visualization with the camera 18.

A further embodiment includes a vaginal speculum with visualizationdevice, generally 260 as shown in FIG. 19. Any speculum 261, includingdisposable, generally known and used for a pelvic exam can be equippedwith a visualization device, generally 10, which comprises a camera 18placed inside of a camera tube 12. The camera tube 12 can be attached tothe speculum 261 or to some other instrument. The camera 18 is placed inthe camera tube 12 through an opening at a proximal end 16 and is movedall the way toward the distal end 14 which is sealed with a transparentmaterial 17. The camera 18 connected to at least one monitoring deviceby electric wire 20 or the camera 18 can be connected wirelessly.

Further embodiments relate to various tubing equipped with avisualization device shown in FIG. 1A and as described in more detailbelow.

FIGS. 20A-20F refer to various embodiments for a nasal cannula with avisualization device, generally 270. FIG. 20A shows the positioning of anasal cannula 272 on patient's head with a visualization device 10 addedto one of the two nostril tubes. The nasal cannula 272 can be any nasalcannula known in the art and used by medical practitioners. Thevisualization device 10 is as described in connection with FIG. 1A andcomprises a camera 18 inserted inside of a camera tube 12. The cameratube 12 is sealed or otherwise attached externally along at least onenostril tube 274 of the nasal cannula 272 as shown in more detail inFIG. 20C. This nasal cannula with the visualization device 10 providescontinuous visualization of vocal cords, upper esophagus. The cannulacan be used to determine whether vocal cords are moving correctly, ifthere is any abnormal anatomy and the color of the patient's tissues.

As shown in FIG. 20E, the nasal cannula with the visualization devicecan be properly positioned through patient's nostrils as the positioningis guided and constantly visualized with the camera device 10. Thedistal end 14 of the camera tube 12 aligns with the distal end of atleast one nostril tube 274. As shown in FIG. 20F, the nasal cannula withthe visualization device can be further equipped with an externalstethoscope 275, which can be placed on patient's chest externally andmonitors breathing and heart-beat sounds.

FIGS. 20B and 20D show the same embodiment as in FIGS. 20A and 20C,except the visualization device 10 is equipped with a light source 21 aswas described in connection with the light source 21 in otherembodiments.

A further embodiment includes a feeding tube with a visualizationdevice, generally 280, as shown in FIG. 21. A visualization device,generally 10, is sealed or otherwise attached externally along theproximal-distal (282A-282B) axis of a feeding tube 282. Thevisualization device 10 is essentially the same as described inconnection with FIG. 1A and other embodiments above. It comprises acamera tube 12 with a proximal end 16 and a distal end 14. A camera 18with wire 20 is inserted into the camera tube 12 through an opening atthe proximal end 16 and is slid all the way to the distal end 14 whichis sealed with a transparent material 17. The camera 18 does not come incontact with a patient's body and can be reused in multiple devices. Anyfeeding tubes known in the art can be used in this embodiment, includinga feeding tube with a stylet 284 as shown in FIG. 21. The feeding tube282 can be equipped with an adaptor 283 at the proximal end 282A. Thefeeding tube 282 may further comprise a plurality of holes 285 at thedistal end 282B for food distribution.

Further embodiments provide various suction tubes equipped with avisualization device, generally 290, as shown in FIGS. 22A, 22B and 22C.Any suction tube including but not limited to the nasal gastric tubesknown in the art can be used and in general a suction tube 292 with anadaptor 293 at a proximal end 292B is suitable, as shown in FIG. 22A. Avisualization device, generally 10, comprises a camera tube 12 and acamera 18 with wire 20. The camera 18 is inserted into the camera tube12 through an opening at a proximal end 16 and is slid all the way tothe distal end 14 of the camera tube 12. The distal end 14 is sealedwith a transparent material 17. The camera 18 can transmit informationto a remote location.

The camera tube 12 is placed inside of the suction tube 292 through anopening 294 at the proximal end 292B of the suction tube 292. The cameratube 12 is then aligned with the length of the suction tube 292 suchthat the distal end 14 of the camera tube 12 is in close proximity withthe distal end 292A of the suction tube 292.

FIGS. 22B and 22C is a further embodiment of a suction tube with avisualization device, generally 290 as shown in FIG. 22A, but it isfurther equipped with a bougie 116 placed inside of a tube 118 which isplaced inside of the suction tube 292 through an opening 295. A distalend 116A of the bougie 116 can protrude outside the distal end 292A ofthe suction tube 292 and can be manipulated by a medical practitionerwith a proximal end 116B which protrudes outside a patient such as theplacement of the suction tube 292 is guided under constant visualizationwith the camera 18 through the distal end 14 of the camera tube 12. Thebougie 116 under constant visualization from the camera 12 permits rapidand accurate placement of the device 290 in a patient. The bougie 116can be used to guide the placement of the device 290 and moving it leftor right in the trachea.

Referring to FIG. 23, this embodiment provides a suction catheter with avisualization device, generally 300. The suction catheter 302 is notflexible and can be any suction catheter known in the art. Avisualization device, generally 10, is positioned inside the suctioncatheter 302 through an opening 303 which is in near proximity with aproximal end 302B of the suction catheter 302. The visualization device10 comprises a camera 18 with wire 20 which is placed inside of a cameratube 12 through an opening at a proximal end 16 of the camera tube 12and then the camera 18 is slid to the distal end 14 which is sealed witha transparent material 17. The distal end 14 of the camera tube 12 isaligned with the distal end 302A of the suction catheter 302, while theproximal end 16 of the camera tube 12 protrudes outside the patient'sbody such as the camera 18 can be pulled out from the camera tube 12 asneeded. In other embodiments, the suction tube is placed externally andthis combination can work with suction caps.

Referring to FIG. 24, this embodiment provides an endotracheal changingtube with a visualization device, generally 310. An endotrachealchanging tube can be any endotracheal changing tube as known in the art.A visualization device, generally 10, comprises a camera 18 with wire 20which is placed inside of a camera tube 12 through an opening at aproximal end 16 of the camera tube 12 and slid all the way to a distalend 14 of the camera tube 12. The distal end 14 is sealed with atransparent material 17. The visualization device 10 is placed inside ofthe endotracheal changing tube 312 through an opening 313 in thechanging tube 312 such as the camera tube 12 is aligned with thechanging tube 312 along the proximal-distal (312B-312A) axis, and thedistal end 14 of the camera tube 12 is in close proximity with thedistal end 312A of the changing tube 312. In other embodiments, thecamera tube 12 can be placed outside of the endotracheal changing tubeor it can be fitted externally onto an endotracheal changing tube knownin the art.

Further embodiments include a supraglottic ventilating tube with camera,generally 360 as shown in FIGS. 25A-25D. As can be appreciated from FIG.25A, the device 360 comprises a tube 361 with the distal end 361A andthe proximal end 361B. The device 360 is equipped with a visualizationdevice 10 as described in connection with FIGS. 1A, 1B and 1C and whichcomprises a camera tube 12 attached externally to the device 360. Adisposable camera 18 can be inserted into the camera tube 12 along witha light source 362. In proximity to the distal end 361A, the device 360comprises an inflatable cuff 364 which wraps around the tube 361. Thecuff 364 can be inflated with a means 366 after the esophageal cameratube is positioned in a patient.

As can be appreciated from FIG. 25B, the camera tube 18 is positionedunder the cuff 364 such that the cuff 364 wraps over the camera tube 12.The camera tube 12 can slide along the tube 361 such that images withthe camera 18 can be taken either proximally or distally from the cuff364 after the cuff 364 is inflated in the patient.

As shown in FIGS. 25C and 25D, the device 360 can be placed inside theintubating/extubating oral airway device 350, including theintubating/extubating oral airway device 350 shown in FIGS. 16H, and16J-16K. As can be appreciated from FIG. 25D, the device 360 can beeasily inserted into a patient with help of the intubating/extubatingoral airway device 350. Supraglottic ventilating tube can be positionedunder the direct and continuous visualization into patient'shypopharynx. The device 350 can be removed after the insertion iscompleted.

Further embodiments provide a tubeless intubating device shown in FIGS.26A-26J, generally 370. The tubeless intubating device 370 has the uppersurface shown in FIG. 26A and the bottom surface shown in FIG. 26B. Thetubeless intubating device 370 comprises an ellipsoid body 372 which hasan upper oval surface 373 with a lumen opening 374A on the upper ovalsurface 373 of the ellipsoid body 372 as shown in FIG. 26A. The upperoval surface 373 is connected to the bottom half-ellipsoid surface 378as shown in FIG. 26A and FIG. 26B such that the distal end 376 of theellipsoid body 372 is tapered because the bottom half-ellipsoid surface378 is tapered at the distal end 376. The ellipsoid body 372 encloses alumen 374 which opens onto the upper oval surface 373 with the lumenopening 374A. The lumen 374 opens on the proximal side of the bottomhalf-ellipsoid surface 378 with a canal 379 which connects to the bottomhalf-ellipsoid surface 378 and extends beneath the bottom half-ellipsoidsurface 378. The bottom half-ellipsoid surface 378 also connects to ahandle 380.

The handle 380 comprises three parts connected together: the proximalpart 380A, the middle part 380B and the distal part 380C. The proximalpart 380A may be made in flat rectangle shape with a ring-holder 382attached on the bottom surface of the proximal part 380A. The 380A partbends down at about a 90 degree angle at its distal part where itconnects to the middle part 380B. The middle part 380B is also of flatrectangle shape and may vary in length. As can be seen from FIG. 26B,the canal 379 is connected to the bottom surface of the middle part 380Bat the distal portion of the middle part 380B. The middle part 380Bconnects to the distal part 380C at its distal end. The middle part 380Bbends up at about a 90 degree angle at the distal part and connects tothe distal part 380C. The distal part 380C connects by its distal end tothe oval upper surface 373 of the ellipsoid body 372.

A visualization device, generally 10, comprising the camera tube 12 andcamera 18 which can be inserted into the camera tube 12, is attached tothe handle 380 on its upper surface such as the visualization device 10extends along the handle 380 from its proximal end 380A at which thecamera 18 is inserted insider the camera tube 12 and all the way intothe distal portion 380C. Just like in other embodiments, the camera tube12 is sealed with a transparent material 17 at its distal end such asthe camera 18 does not come into direct contact with the patient's bodyand can be reused. Just like in other embodiments, the camera tube 18can slide along the proximal-distal axis of the handle 380. Thevisualization device 10 may further comprises a light source 384 whichcan be inserted into the camera tube 12 along with the camera 18. Insome embodiments the ellipsoid body 372 can comprise an inflatable cuff385 which can be inflated with a means 386.

In some embodiments, the handle 380 can be made of flexible material. Inother embodiments, the tubeless intubating device 370 can be designedwithout the cuff 385. In some embodiments, the camera tube 12 is fixedto the handle 380. In some embodiments, the camera tube 12 includes alight source. In other embodiments, the camera tube 12 has no additionallight source.

The tubeless intubating device 370 can be used for intubating a patientwith an endotracheal tube of any size under continuous visualization ofthe camera 18. The tubeless intubating device 370 can be also used forextubation and for reintubation of a patient. It can also act as asupraglottic device with an endotracheal tube inflated with the cuff385.

As shown in FIG. 26C, an endotracheal tube 388 can be loaded onto thetubeless intubating device 370 such that the proximal end of theendotracheal tube 388 is secured on the tubeless intubating device 370with the ring holder 382. It will be appreciated that any endotrachealtube can be loaded into the device 370 and inserted into a patient. Ascan be seen in FIG. 26C, the endotracheal tube 388 in this embodiment isequipped with a cuff 390. The endotracheal tube cuff 390 can be inflatedafter it is loaded into the device 370 and secured in place with thering holder 382. It will be appreciated that the embodiments of thedevice 370 shown in FIGS. 26A-26C are equipped with the cuff 385 and thecuff 385 of the structure can be inflated in the hypopharynx.

The distal end of the endotracheal tube 388 is then passed through thecanal 379 and through the lumen 374 such that the distal end of theendotracheal tube 388 protrudes from the lumen opening 374A on the upperoval surface of the ellipsoid body 372, as shown in FIGS. 26D and 26E.The endotracheal tube 388 can slide along the proximal-dorsal axis ofthe tubeless intubating device 370 such that a longer or shorter portionof the endotracheal tube 388 protrudes from the lumen opening 374A.

As can be further appreciated from FIG. 26F, after the tubelessintubating device 370 delivers and assists in placing the endotrachealtube 388 in the patient under direct and continuous visualization, thetubeless intubating device 370 can be easily removed from the patientwhile the endotracheal tube 388 remains safely in place under continualvision. Thus, the tubeless device 370 can be used with a standardendotracheal tube to intubate and extubate a patient. The device 370 canbe also used as a supraglottic device.

Further embodiments of the tubeless intubating device 370 are shown inFIGS. 26G-26J. As shown in FIG. 26G and can be particularly appreciatedfrom FIG. 26H, the tubeless intubating device 370 in these embodimentsdoes not comprise a cuff. Nevertheless and just like the tubelessintubating device 370 of FIG. 26A, the device 370 of FIG. 26G has theupper surface shown in FIG. 26G and the bottom surface shown in FIG.26H. The tubeless intubating device 370 comprises an ellipsoid body 372which has an upper oval surface 373 with a lumen opening 374A on theupper oval surface 373 of the ellipsoid body 372 as shown in FIG. 26G.The upper oval surface 373 is connected to the bottom half-ellipsoidsurface 378 as shown in FIG. 26G and FIG. 26H such that the distal end376 of the ellipsoid body 372 is tapered because the bottomhalf-ellipsoid surface 378 is tapered at the distal end 376. Theellipsoid body 372 encloses a lumen 374 which opens onto the upper ovalsurface 373 with the lumen opening 374A. The lumen 374 opens on theproximal side of the bottom half-ellipsoid surface 378 as shown in FIG.26H. The bottom half-ellipsoid surface 378 also connects to a handle380. This embodiment of the device 370 does not comprise a canal.

The handle 380 comprises three parts connected together: the proximalpart 380A, the middle part 380B and the distal part 380C. The proximalpart 380A may be made in flat rectangle shape with a ring-holder 382attached on the bottom surface of the proximal part 380A. The 380A partbends down at about a 90 degree angle at its distal part where itconnects to the middle part 380B. The middle part 380B is also of flatrectangle shape and may vary in length. As can be seen from FIG. 26B,the canal 379 is connected to the bottom surface of the middle part 380Bat the distal portion of the middle part 380B. The middle part 380Bconnects to the distal part 380C at its distal end. The middle part 380Bbends up at about a 90 degree angle at the distal part and connects tothe distal part 380C. The distal part 380C connects by its distal end tothe oval upper surface 373 of the ellipsoid body 372.

A visualization device, generally 10, comprising the camera tube 12 andcamera 18 which can be inserted into the camera tube 12, is attached tothe handle 380 on its upper surface such as the visualization device 10extends along the handle 380 from its proximal end 380A at which thecamera 18 is inserted insider the camera tube 12 and all the way intothe distal portion 380C. Just like in other embodiments, the camera tube12 is sealed with a transparent material 17 at its distal end such asthe camera 18 does not come into direct contact with the patient's bodyand can be reused. Just like in other embodiments, the camera tube 12can slide along the proximal-distal axis of the handle 380. Thevisualization device 10 may further comprises a light source 384 whichcan be inserted into the camera tube 12 along with the camera 18.

As shown in FIGS. 26I and 26J, the device 370 can be used for intubationand extubation of a patient with a supraglottic airway, generally 392 inFIGS. 26I and 26J. The device 370 can also be used for placement of alaryngeal mask airway. As shown in FIG. 26J, the supraglottic airway 392is secured in the device 370 with the ring holder 382 such that thedistal end of the device 392 is aligned with the distal end of thedevice 370 and the lumen 394 of the device 392 is aligned with the lumen374 of the device 370 and secured. Because the assembly of the devices370 and 392 is equipped with the camera device 10, it providescontinuous visualization of patient's supraglottic structure duringplacement.

Further embodiments provide a sliding endotracheal cuff device,generally 400 as shown in FIGS. 27A-27G. As can be appreciated fromFIGS. 27A and 27B, an endotracheal tube 410 comprises a tube 412 with aproximal end 412A and a distal end 412B with a rail 414 along theproximal-distal axis (412A-412B) designed such that the endotrachealtube 410 fits inside the device 400 and the rail 414 fits into the rail404 of the device 400. The device 400 can then slide along theproximal-distal axis 412A-412B on the endotracheal tube 410 as shown inFIG. 27B. The details of the device 400 design are further explained inconnection with FIGS. 27C-27F. As can be appreciated from 27C, the rail404 has a groove 405 facing inside the tube 402. The groove 405 isdesigned such that the rail 414 of the endotracheal tube 410 fits insidethe groove 405 and can slide along the rail 404. The rail design permitsto easily remove the endotracheal tube 410 from the device 400 while thedevice 400 remains in place in a patient. In alternative, the device 400can be removed, while the endotracheal tube 410 remains in place in thepatient. Because the device 400 remains in place, changing from oneendotracheal tube 410 to another can be easily accomplished. Furtherbecause the cuff 406 is presented on a separate device, an endotrachealcomponent can remain in place if what needs to be replaced is only acuff. While in drawings of FIG. 27, the device 400 is shown a cylinder,this device can be a half-cylinder in other embodiments.

As can be further appreciated from FIG. 27D, some embodiments for thedevice 400 comprise an additional tube 416 which can be used fordelivering drugs, suction and tools such as for example forceps andbougie. Further embodiments for the device 400 include an embodiment ofFIG. 27E in which the cuff 406 can move along the rail 404. Yet furtherembodiments for device 400 include an embodiment of FIG. 27F, where thedistal portion 402A of the tube 402 comprises mesh 418. As can befurther appreciated from FIG. 27F, the cuff 406 can inflate over themesh 418.

As can be appreciated from FIG. 27G, the camera tube 12 may be fixedalong the body 402 or it can slide proximally and distally along thebody 402. Overall, the device 400 prevents a problem of broken sealafter the device has been in place in a patient for a period of time.

Further embodiments provide an endotracheal tube, generally 430, asshown in FIGS. 28A and 28B. The device 430 comprises a tube 432 with theproximal end 432A and the distal end 432B. A visualization device 10 ispositioned along the proximal-distal axis (432A-432B) of the tube 432.As can be appreciated from FIG. 28B, the visualization device 10comprises a camera tube 12 sealed with a transparent material 17 at thedistal end. A camera 18 can be placed inside the camera tube 12. Thecamera tube 12 comprises a rail 434 running along the camera tube 12.The tube 12 further comprises a half-cylinder 436 attached on the sideopposite to the side of the tube 12 to which the rail 434 is attached.The half-cylinder 436 has a diameter such that the visualization device10 can be easily snap over the tube 432 of the endotracheal tube 430with the half-cylinder 436. Thus, the visualization device 10 in thisembodiment can be easily assembled with any endotracheal tube and it canalso be easily removed from the endotracheal tube when visualization isno longer needed. Importantly, the camera tube can be detached at anytime. Thus, this device is similar to a laryngoscope, yet the cameratube can be removed at any time if no longer needed. Thus, one of theadvantages of this device is a rail which permits gliding along anyother tubal device.

Further embodiments provide a sliding camera tube with rail, generally440 as shown in FIGS. 29A-29C. As can be appreciated from FIG. 29A, thecamera tube 440 comprises a tube into which a camera 18 can be inserted.The tube 12 is sealed at the distal end with transparent material 17. Arail 442 runs along the tube 12. The tube 12 is attached to ahalf-cylinder 444 which has a diameter such as the camera tube 440 canbe easily assembled with an endotracheal tube or any other tube and itcan glide along the endotracheal tube or any other tube. As can beappreciated from FIG. 29A, the camera tube 440 can easily slide into alaryngoscope which is equipped with a rail 448 along which the cameratube 440 can slide. As can be appreciated from FIG. 29B, after thecamera tube 440 is positioned on the laryngoscope, the camera 18 can beinserted into the tube 12.

As can be further appreciated from FIG. 29C, the camera tube 440 can beeasily removed from the laryngoscope and assembled with any otherdevice. For example, the camera tube 440 can be placed on anendotracheal tube as was discussed in connection with FIG. 28. Thus, thedevice provide intubation during laryngoscopy and after the removal ofthe device 440 from the device 448.

Further embodiments provide a supraglottic airway device with built inendoscope guide, generally 450, as shown in FIGS. 30A and 30B. As can beappreciated from FIG. 30A, the device 450 comprises a camera tube 12which is positioned externally long the body of the device 450. Thedevice 450 is further equipped with a half-cylinder endoscope guide 452which runs externally along the body 451 of the device 450, beneath acuff 454 and creates a semi-lumen. The device 450 can be used forplacing a supraglottic airway with an endoscope in place. The device 450is adoptable to endoscopes of all sizes. The device 450 can be placedafter an endoscope is already inserted in a patient. The device 450 isable to ventilate a patient under continuous visualization duringendoscopy. As can be further appreciated from FIG. 30B, the device 450can be positioned in the patient's oral cavity 456 and then it can beeasily removed from the endoscope semi-lumen 452.

FIGS. 31A and 31B provide further embodiments for an assembly with anaso-gastric tube with a visualization device 10, generally 460. Thevisualization device 10 comprises a camera tube 12 with a camera 18which can be inserted inside the camera tube 12. The naso-gastric tube461 comprises a valve 462. The assembly 460 further comprises an oxygentube with perforations, 464, which can be connected to a source ofoxygen 468. As can be appreciated from FIGS. 31A and 31B, theperforations 466 are located at the distal end of the tube 464 and thispermits localization of the perforations in the mid pharynx to deliveroxygen to a patient as shown in FIG. 31A. The length of the camera tube12, oxygen tube 462 and naso-gastric tube 461 are calculated such thatthe assembly is flexible and the camera tube 12 can be located in themid pharynx. However, the camera tube 12 can slide on the gastric tube461 to travel to the distal gastric tube 461 providing continuousvisualization of patient's gastric organs. A person of skill willappreciate that in some embodiments, the assembly 460 comprises anaso-gastric tube 461 as shown in FIG. 31A, while in other embodiments,the assembly 460 comprises a feeding tube 470 in place of thenaso-gastric tube 461.

FIG. 32 is a further embodiment of an oral airway with a camera device,generally 480. The oral airway comprises a tubal body 482 with a lumen484 similar to tubal bodies of other oral airways described in thisdisclosure. The camera device 10 comprises a camera tube 12 which issealed at its distal end with transparent material 17 and into which acamera 18 can be placed.

The camera device 10 is placed inside the lumen 484. The oral airwaydevice 480 can provide continuous visualization of patient'ssupraglottic structure including the vocal cords in patients withpositive ventilation pressure and also in patients ventilatingspontaneously. The oral intubating device 480 can be used to place anendotracheal tube through the vocal cords without lifting the mandible.As in previous embodiments, the device 480 provides a continuousvisualization after the endotracheal tube is placed and duringextubation. It should be understood that this camera tube can slideproximal and distal to the tip of the device 480. A bougie 486 is alsoplaced inside the lumen 484 and it can be moved along theproximal-distal axis and guide positioning of the camera device 10 whichalso can move along the proximal-distal axis. The device 480 furthercomprises a suction catheter 488 which is also placed inside the lumen484 and which can move along the proximal-distal axis inside the lumen484. As can be appreciated by a person of skill, an endotracheal tubecan be placed inside the lumen 484 to intubate a patient.

FIGS. 33A-33C are further embodiments of an endotracheal tube 490 withan externally attached camera tube 12 into which a camera 18 can beplaced, and a suction tube 492 which is also attached externally to theendotracheal tube 490 as shown in FIG. 33A. As shown in FIG. 33B andFIG. 33C other devices can be externally attached to the endotrachealtube 460, such as a medication dispensing device 494 as shown in FIG.33B and biopsy forceps 496 as shown in FIG. 33C. Additionally, aventilating tube can be placed in can be added to the assembly. Anadditional balloon can be added circumferentially around the camera tubeto provide ventilation. This system can be also used to separateventilation between the left and right bronchus. Because the camera tube12 and the suction tube 492 are secured on the endotracheal tube 490with a set of rings, the attachment is flexible and each of the cameratube 12 and suction tube 492 can rotate 360 degrees around theendotracheal tube 490. In addition to be able to rotate around theendotracheal tube 490, the camera tube 12 and suction tube 492 can slidealong the proximal-distal axis of the endotracheal tube. The camera tube12 is sealed at the distal end with transparent material 17 and thisallows the camera 18 to visualize the external structures in the airwayincluding but not limited to the vocal cords.

FIGS. 34A-34H are further embodiments of an oral airway device,generally 500, that allows for continuous visualization of the patient'svocal cords. As shown in FIG. 34A, the device comprises a tubal body 502with a lumen 504 into which an endotracheal tube 506 or any othersimilar device can be inserted. The tubal body 502 has a proximal end502A and a distal end 502B. The visualization device 10 is positionedalong the tubal body 502 externally and it comprises a camera tube 12sealed at the distal end with transparent material 17, and a camera 18which can be used in multiple applications as it does not come into adirect contact with the patient's body. The positioning of the cameradevice provides for continuous visualization in the anteriorly lumen. Anadditional tubal body with a lumen 508 is attached along theproximal-distal axis of the tubal body 502. This additional tubal body508 can be used for positioning an esophageal blocker 510 which can bethen placed in the patient's esophagus under direct visualization withthe visualization device 10. The esophageal blocker 510 is equipped witha balloon 512 at the distal end. The balloon 512 can be inflated with ameans 514 and seal the patient's upper esophagus. In addition, thedevice 500 is equipped with a second balloon 516 which iscircumferential and runs around the bodies 502 and 508, and locatedproximally to the balloon 512. The balloon 516 can be used to inflatewith a means 518 and used for sealing the upper pharynx. Thus, thedevice 500 may act as a supraglottic airway with the endotracheal tube506 pulled back proximally in the device 500 with the endotracheal tube506 inflated.

Alternatively and as shown in FIG. 34B, the endotracheal tube 506 may beremoved and a ventilator cap 520 can be placed proximally in the centraloral airway lumen to ventilate the patient as a supraglottic device. Thedevice 500 may allow ventilating as a supraglottic airway undercontinuous and direct visualization with the visualization device 10.The device may also revert back to place an endotracheal under directvisualization.

FIGS. 34C and 34D provide a further embodiment for an oral airwaydevice, generally 500, but in which the visualization device 10 ispositioned internally and inside the lumen 504. FIG. 34C includes anendotracheal tube 506 which can be placed inside the lumen 504, as wasdiscussed in connection with FIG. 34A. Further and as shown in FIG. 34D,the device 500 can be also used a ventilation cap 520.

One of the significant differences between the oral airway device 500 asembodied in FIGS. 34C and 34D versus the embodiments of FIGS. 34A and34B, the device 500 in of FIGS. 34C and 34D does not comprise a balloon.The body 502 of the device 500 however, comprises at least oneretractable extension 522.

As shown in FIG. 34E, the oral airway device 500 of FIGS. 34C and 34Dcan be used in a combination with a carrier device 540. As shown inFIGS. 34E and 34F, the carrier device 540 comprises a tubal body 542with a lumen 544. Two balloons are sealed to the carrier body 542. Thefirst balloon, 548, caps the distal end of the carrier body 542. Thefirst balloon 548 can be inflated with a means 549. The second balloon,550, is proximal to the first balloon 548, and it rounds around thecarrier body 542. The second balloon 550 can be inflated with a means551.

The carrier body 542 comprises an opening 546 which is located on thecarrier body 542 between the first balloon 548 and the second balloon550. Thus, the lumen 544 opens with the opening 546 on the carrier body542. The carrier body 542 is equipped with a glide rail 552 which runsalong at least a part of the carrier body 542. The carrier body 542 isfurther equipped with a handle 554 which allows the carrier device 540to be pushed, pulled and or turned from side to side.

As can be appreciated from FIG. 34E, the oral airway device 500 can beinserted into the lumen 544 of the carrier device 540. The extension 522of the body 502 can glide along the glide rail 552 until the device 500is positioned inside the lumen 544. As can be appreciated from FIGS. 34Gand 34H, the device 500 can glide up and down inside the carrier 540,this allows an endotracheal tube to be placed proximally in its centrallumen 544.

As shown in previous embodiments, the device 500 as a whole maybeadvanced distally or brought proximally to align the central lumenbetween the two balloons 548 and 550 to visualize the vocal cords. Anendotracheal tube thus can be advanced under direct and continuousvisualization by the camera device 10. If needed, the endotracheal tubecan be withdrawn from the trachea altogether or partially within theproximal lumen 504 (balloon on endotracheal tube inflated) to beconverted to a supraglottic device.

The balloons 548 and 550 can be inflated and thus occluding the upperesophagus distally and pharynx proximally. This can be accomplishedunder direct and continuous vision of both the vocal cords, glotticstructures and upper esophagus and hypo pharynx by the visualizationdevice 10. The ventilating cap 520 can be placed in the central proximallumen 504 if an endotracheal tube is absent.

FIG. 35A depicts an oral airway device 560 with a camera tube 12positioned in the patient's mouth. The camera tube 12 is as in priorembodiments with sealed distal end and open proximal end. The oralairway device 560 has a central lumen 564 to allow an endotracheal tube562 to enter and slide down distally. The oral airway device 560 has acurvature and length to allow the oral airway device 560 to go under theepiglottis and actually touch the patient's vocal cords. Thus, nolifting of the mandible or tissue is needed. This new methodology ofintubation allows greater ease and less skill to master then all theother forms of intubation such as laryngoscopy, videolaryngoscopy orfiberoptic intubation.

Once the distal end of the oral airway device 650 is touching or justproximal to the patient's vocal cord, the endotracheal tube 562 canslide proximal to distal in the central lumen 564 through the vocalcords under direct and continuous visualization by the camera 18. Oncethe endotracheal tube 562 is placed and secured the oral airway device560 still maintains direct and continuous visualization of theendotracheal tube 562 and the patient's vocal cords.

The further details of the oral airway device 560 can be appreciatedfrom FIG. 35B where it is shown that the side 566 of the oral airwaydevice 560 is open to allow the endotracheal tube 562 to be removedlaterally from the central lumen 564 of the oral airway device 560 ifneeded. As can be further appreciated from FIG. 35B, the device 560 canbe further equipped with a cap 568 which can be designed in multipledifferent sizes and can be placed or removed to add or shorten the oralairway device 560 to properly adjust to patients of different sizes. Thecap 568 still has a side 570 removed as shown in FIG. 35B to allow anendotracheal tube to be removed from the central portion of the oralairway device 560 laterally. In addition, the cap 568 can be removed androtated 180 degrees to help hold the endotracheal tube in place.

FIGS. 36A, 36B and 36C depict a nasopharyngeal airway device, generally580. The device comprises a tubal body 582 with a camera tube 12positioned internally. The distal end of the camera tube 12 is sealedwith transparent material 17. A camera 18 is placed inside the cameratube 12. The tubal body 582 has a closed distal end with an occludingsoft balloon 584 just proximal to the tip of the body 582. The balloon584 can be inflated with a means 585. Proximally, to the distal balloon584 is an open lumen (vocal cord visualization lumen) 586 that has thedistal camera tube 12 situated to view anteriorly towards the vocalcords. The vocal cord visualization lumen 586 is proximate to the mainlumen 588 in the nasopharyngeal airway tubal body 582. The lumen 588runs proximally to the distal end merging into the visualization opening586 that houses the camera tube 12.

A larger balloon 590 maybe placed proximal to the vocal cordvisualization camera lumen 586. The balloon 590 may be inflated with ameans 591. The balloon 590 may occlude the posterior pharynx.Additionally, another balloon 592 could be situated proximally to thepharyngeal cuff balloon 590, as shown in FIG. 36B. The balloon 592 canbe inflated with a means 593.

These balloons ideally occlude the upper esophagus (hypopharynx),pharynx and nasal septum. These balloons may have separate pilot cuffsor share one pilot cuff to one or more balloons. A standard 15 mm cap(not shown) maybe attached to the proximal portion of the nasopharyngealdevice to provide positivity pressure ventilation with a sealedhypopharynx and pharynx with the balloons in place and inflated.

As shown in FIG. 36C, the device 580 is placed in a patient and theballoons are inflated in the nasalseptum, pharynx and hypopharynx. Thevisualization camera lumen 586 can be easily aligned to the vocal cordsvisualized anteriorly under direct and continuous visualization. Aventilator cap is available to be placed proximally to provide positivepressure ventilation. This device can be a rescue device to providecontinual visualization of the vocal cords while maintaining a closedsystem.

While certain medical devices are described above, a person of skillwould appreciate that this invention also includes embodiments withvarious obvious modifications as would be easily apparent to a person ofskill.

What is claimed is:
 1. An oral airway device comprising a tubal bodywith a central lumen and a visualization device attached to the tubalbody, wherein the diameter of the lumen is such that an endotrachealtube can be placed inside the lumen; wherein the visualization devicecomprises a camera tube sealed at the distal end with a transparentmaterial and a camera placed inside the camera tube through the openingat the proximal end, and wherein the camera tube is positioned along thetubal body.
 2. The oral airway device of claim 1, wherein thevisualization device is attached along the tubal body externally.
 3. Theoral airway device of claim 1, wherein the visualization device isplaced inside the lumen and attached to the tubal body internally. 4.The oral airway device of claim 1, wherein the device further comprisesa holder connected to the proximal surface of the oral airway device anda removable handle which can be attached to the holder.
 5. The oralairway device 1, wherein the tubal body creates a rotating centralpassageway made of two half-cylinders, a first external half-cylinderand second internal half-cylinder, wherein the second half-cylinder fitsinside the first half-cylinder and can glide inside the firsthalf-cylinder along the proximal-distal axis of the first half-cylinderand wherein the second half-cylinder can also rotate inside the firsthalf-cylinder and thereby create a completely enclosed centralpassageway or only partially enclosed central passageway with a lateralopening, and wherein the first half-cylinder and the secondhalf-cylinder can be separated from each other.
 6. The oral airwaydevice of claim 5, wherein the camera tube is attached externally to thefirst half-cylinder.
 7. The oral airway device of claim 5, wherein thecamera tube is attached internally to the second half-cylinder.
 8. Theoral airway device of claim 5, wherein the second half-cylinder has atleast one retractable extension on the second half-cylinder body whichwhen extended outside the second half-cylinder body secures thepositioning of the second half-cylinder inside the first half-cylinderand prevents further distal sliding of the second half-cylinder insidethe first half-cylinder.
 9. The oral airway device of claim 5, whereinthe camera tube is placed inside the second half-cylinder.
 10. Asupraglottic ventilating device, comprising a ventilating tube with thedistal end and proximal end, and equipped with a visualization devicecomprising a camera tube attached externally along the ventilating tube,and a camera which can be placed inside the camera tube, wherein aninflatable cuff wraps around the ventilating tube and the camera tube ispositioned under the cuff and can slide distally under the cuff.
 11. Thesupraglottic ventilating tube of claim 10, further comprising a built-inendoscope guide.
 12. A method for intubating a patient, the methodcomprising loading an endotracheal tube or ventilating tube onto thesecond half-cylinder of the oral airway device of claim 5, assemblingthe second half-cylinder with the first half-cylinder, and inserting theassembly into a patient while continuously monitoring the positioningand movement of the assembly inside the patient with the visualizationdevice attached to the oral airway device.
 13. A tubeless intubatingdevice, comprising an ellipsoid body attached to a handle and avisualization device attached to the intubating device, wherein thevisualization device comprises a camera tube with the sealed distal endand a camera which can be placed and removed from the camera tube, andwherein the ellipsoid body comprises a lumen with one opening on theupper surface of the ellipsoid body and the other opening of the bottomsurface of the ellipsoid body and wherein the proximal end of the handleis equipped with a ring holder suitable for holding at least one of thefollowing devices: an endotracheal tube, supraglottic airway andlaryngeal mask airway.
 14. A method of intubating and extubating apatient, the method comprising loading at least one of the followingdevices: an endotracheal tube, supraglottic airway and laryngeal maskairway on the tubeless intubating device of claim 13, securing thedevice on the tubeless intubating device with the ring holder andinserting the assembly into a patient under continuous visualizationwith the visualization device attached to the intubating device.
 15. Thetubeless intubating device of claim 13, wherein the ellipsoid body isequipped with a cuff.
 16. A sliding endotracheal cuff device, comprisinga tube with the distal end and the proximal end, a rail attachedexternally on the tube along the proximal-distal axis, wherein the railhas a groove which opens insider the tube, wherein the device furthercomprises a cuff which wraps around the tube externally at the distalportion of the tube, and wherein the device further comprises a cameratube attached externally to the tube along the proximal-distal axis, anda camera which can be positioned inside and removed from the cameratube.
 17. The sliding endotracheal cuff device of claim 16, wherein thegroove of the tube is designed such that it accommodates a rail of anendotracheal tube placed inside the sliding endotracheal cuff device.18. The sliding endotracheal cuff device of claim 16, wherein the distalportion of the tube comprises a mesh.
 19. The oral airway device ofclaim 1, wherein the device comprises a second tubal body attachedexternally to the tubal body with the central lumen.
 20. The oral airwaydevice of claim 1, wherein the oral airway device is assembled togetherwith a carrier, wherein the carrier comprises a tubal body with lumeninto which the oral airway device can be placed, wherein a first ballooncaps the distal end of the carrier, wherein the carrier has a lumenopening proximal to the first balloon, wherein the carrier has a secondballoon circumventing the tubal body of the carrier proximally to thelumen, wherein the carrier may further optionally comprise a thirdballoon circumventing the body of the carrier proximally to the secondballoon, and wherein the balloons can be inflated with an inflatingmeans.